Adjunctive Therapy to Manage Neuropsychiatric Symptoms in Moderate and Severe Dementia: Randomized Clinical Trial Using an Outpatient Version of Tailored Activity Program

Abstract

Background: Neuropsychiatric symptoms (NPS) such as aggression, apathy, agitation, and wandering may occur in up to 90%of dementia cases. International guidelines have suggested that non-pharmacological interventions are as effective as pharmacological treatments, however without the side effects and risks of medications. An occupational therapy method, called Tailored Activity Program (TAP), was developed with the objective to treat NPS in the elderly with dementia and has been shown to be effective. Objective: Evaluate the efficacy of the TAP method (outpatient version) in the treatment of NPS in individuals with dementia and in the burden reduction of their caregivers. Methods: This is a randomized, double-blind, controlled clinical trial for the treatment of NPS in dementia. Outcome measures consisted of assessing the NPS of individuals with dementia, through the Neuropsychiatric Inventory-Clinician rating scale (NPI-C), and assessing the burden on their caregivers, using the Zarit Scale. All the participants were evaluated pre-and post-intervention. Results: 54 individuals with dementia and caregivers were allocated to the experimental (n = 28) and control (n = 26) groups. There was improvement of the following NPS in the experimental group: delusions, agitation, aggressiveness, depression, anxiety, euphoria, apathy, disinhibition, irritability, motor disturbance, and aberrant vocalization. No improvement was observed in hallucinations, sleep disturbances, and appetite disorders. The TAP method for outpatient settings was also clinically effective in reducing burden between caregivers of the experimental group. Conclusion: The use of personalized prescribed activities, coupled with the caregiver training, may be a clinically effective approach to reduce NPS and caregiver burden of individuals with dementia.

Integrative Stress Reduction Program for Family Caregivers of Persons With Advanced Dementia: A Randomized-Controlled Trial

“…We found a small but significant effect on decreased neuropsychiatric symptoms among people with dementia; the reduction of symptoms may have contributed to lowering caregiver stress levels. 33 Learning to manage these symptoms is challenging, and caregivers were able to implement changes that could improve their quality of life. Other researchers have reported reduced stress even when dementia symptoms improved a small amount.…”

Occupational Therapy Interventions for Dementia Caregivers: Scoping Review

“…Another reason that may explain why it is the caregiver’s behavioural aspects that are most affected and therefore most studied in the included articles is the existence of NPS in the people with dementia. NPS are very common in PwD [ 68 ] and are associated with an increased level of stress caregivers [ 69 ], which could lead to an increased burden [ 70 ].…”

Non-pharmacological Intervention for Wandering Behavior in Dementia: A Systematic Review and Meta-analysis

“…을 조정하는 프로그램인 신경인지적 요인에 대한 중재[31], 걷 기 프로그램과 같은 운동요법[30]은 통계적으로 유의한 결과 를 보고하였다. 그러나, 정신 심리적 요인을 감소시키기 위한 신체 접촉 또는 아로마 요법은 3편에서는 유의한 결과를 보고 하였으나[34][35][36], 1편에서는 통계적으로 유의하지 않았으며[33], 익숙한 환경과 과거회상요법 또한 통계적으로 유의한 효 과를 보고하지 않았다[32].Figure 2.…”