Intervención terapéutico-cognitiva individual de los síntomas psicológicos y conductuales de pacientes con demencia (estudio PRESTA)

Abstract

Introduction

The behavioural and psychological symptoms of dementia (BPSD) are frequently associated with patients with dementia, aggravating their cognitive and behavioural status, which generates anguish for their main caregivers. Non-pharmacological therapies are a method to approach BPSD.

Aim

To analyse the effectiveness of a behavioural educational intervention and support to the family caregiver in reducing overload, and whether this reduction has a positive impact on the BPSD of the patient with dementia.

Method

A randomised, controlled, double-blind trial was conducted with patients with dementia and their principal caregivers (PC). The PC were randomised to either the intervention (IG) or control group (CG). The intervention comprised an individual cognitive-behavioural education intervention performed by outpatient nursing, with periodic telephone contacts, over 3 months. The CG received treatment as usual. Cognitive function was assessed using the cognitive scale Mini-Mental State Exploration (MMSE), Neuropsychiatric inventory (NPI-10) and depressive Geriatric Depression Scale (GDS). And caregiver-reported burden using the Zarit Caregiver Burden Inventory. The qualitative and qualitative data of the BPSD were collected at baseline and after the intervention.

Results

The mean total age of the patients was 78.96 (± 6.64) years, and 50% were men. And in the PC (n = 28) it was 58.64 (± 11.69) years, and 92.9% were women. The IG (n = 13) showed a better score than the CG (n = 15) in the MMSE P<.001 and the GDS P<.001, although without changes in the NPI-10 (P=0,419), between the start visit and at 3 months, indicating improvement in cognitive and depressive symptoms after the intervention. The PC also obtained statistically significant scores on the Zarit scale (P=.010). BPSD improved significantly in the IG: repetition P<.001, depression (P =.013), apathy and indifference (P=.003), sleep and diurnal rhythm disorders (P=.006), and eating disorders (P=.019) at 3 months. Clinicaltrials.gov Identifier: NCT03732521.

Conclusions

Non-pharmacological therapy of individual therapeutic-cognitive intervention targeted at caregivers and carried out by nursing personnel expert in its management, has a favourable impact on the control and reduction of the BPSD of patients with dementia.