Nondrug Treatments for Neuropsychiatric Symptoms in Dementia

Given the lack of a good evidence base for pharmacological treatment of neuropsychiatric symptoms of dementia, are there any effective treatments for such problems as agitation, aggression, delusions, hallucinations, repetitive vocalizations, and wandering? A recent review suggests that nondrug interventions that address behavioral issues and unmet needs may be helpful, as may caregiving interventions and the use of bright light therapy.

Dr Liat Ayalon and colleagues reviewed studies that assessed the effectiveness of nonpharmacological interventions in dementia. The authors used American Psychological Association guidelines to determine inclusion criteria. They found that only 3 randomized controlled trials (RCTs) and 6 single-case design studies (SCDs) met their criteria. The analysis was published in the November 2006 issue of Archives of Internal Medicine.

One SCD (N = 8) examined individualized treatment, in which the clinician designed a treatment plan around the patient's negative symptom. At least 1 problem behavior was improved in all participants. Four SCDs studied behavioral modifications (eg, giving or taking away rewards for behaviors) in patients with dementia. All participants' disruptive behaviors were significantly reduced following intervention and there was a 50% to 80% reduction in wandering frequency and a 100% reduction in physical and/or verbal aggression during the treatment phase. The final SCD tested bright light therapy. The authors found that agitation was significantly lower with the bright light; however, the effects did not last beyond 1 day following the intervention.

Two of the RCTs examined showed positive results for caregiver interventions (eg, providing support and education), but the other found no effects on neuropsychiatric symptoms. One RCT found that at least 1 of 3 problem behaviors identified by caregivers improved after the intervention and there was a significant reduction in the frequency of the behavior.

The authors concluded that more high-quality research is needed to confirm their findings and stressed the need for more funding of research in this area and for better quality monitoring of the research that is conducted.