Behavioral disturbances in Alzheimer's disease: a non-pharmacological therapeutic approach.

Abstract

Behavioral disturbances in patients with dementia are among the primary causes of institutionalization. Although the majority of authors agree that such symptoms are well controlled with non-pharmacological support, almost all studies have been focused on symptomatic drug therapy (typical or atypical neuroleptics). The aim of our study was to evaluate the reduction of psychiatric symptoms revealed with the test called empirical behavioral pathology in Alzheimer disease (E-Behave-AD) in a population of patients with AD whose caregivers underwent training to learn various communication strategies to utilize with family members. We evaluated 35 patients with AD (18 males, 17 females, average age 76.5 +/- 5.9 years). Of these patients, 18 (9 males, 9 females, average age 75.1 +/- 6.5 years) were relatives of caregivers who underwent training for six months, four group meetings and two individual ones. During the training, caregivers learned about the possibility of communication with persons with AD. They were taught how to interact with the AD patients in various phases of the illness and how to utilize effectively both verbal and non-verbal language. Other 17 patients (9 males, 8 females, average age 76.1 +/- 4.9 years) were followed as a control group. During the period of observation, all patients were given rivastigmine or donezepil. The two groups were homogenous for age, sex, antipsychotic drug therapy, and initial scores on mini-mental state examination (MMSE), activity of daily living (ADL), instrumental activity of daily living (IADL), and E-Behave-AD. After six months, we evaluated the patients with an analogous battery of tests. The analysis of data proceeded from the verification of homogeneity of test subjects and of the control group with t-test for non-paired data. We used the chi2 statistics to compare the qualitative variables between test subjects and the control group. For all statistical tests, a p < 0.05 was considered significant. In the group of patients with caregivers who underwent training, a statistically significant decrease in the E-Behave-AD score (p < 0.001) was observed after six months (7.7 vs. 10.5; p < 0.001). There was no statistically significant modification in the scores for the ADL, IADL, and MMSE (ADL 4.7 vs. 4.3, p = 0.09; IADL 3.2 vs. 3.1, p =0.4; MMSE 17.3 vs. 15.1, p = 0.1). Numerous evidences in literature underline the centrality of the language deficit in dementia, particularly in AD. A re-establishment, even if partial, of the channels of communication between AD patients and doctors, as well as between patients and caregivers, can reduce the frequency and intensity of behavioral disturbances in persons with AD.