A Chance for the Future: the Underestimated Effect of Specific Non-pharmacological Therapies in Dementia

Abstract

Objectives Three controlled trials with similar study design [Graessel et al. (2011) BMC Medicine 9:129; Pickel et al. (2011) Psychiatrische Praxis 38:389-396; Stemmer et al., in preparation] on non-pharmacological therapies for people with degenerative dementia were recently carried out. Results • Capacities to perform activities of daily living can be stabilised at baseline level for at least 12 months (Cohen’s d = 0.69 for people with mild to moderate dementia) – both by means of unimodal interventions (occupational therapy) or multimodal group therapy (MAKS: motor stimulation, practice in activities of daily living and cognitive stimulation). We therefore suggest that these therapies be called 'Ressource Maintaining Therapies”. • A specific form of cognitive stimulation is required to maintain cognitive performance. If it is 'applied” almost daily the effect can be achieved. Further research is needed to establish exactly where the effectiveness threshold is. • The effect of the therapy shows a trend towards sustainability for the capacity to perform activities of daily living, but less so for cognitive abilities. • Multimodal treatment is definitely superior to unimodal treatment. This is evidenced by the fact that in persons with dementia the behavioural component only shows a clear improve-ment following multimodal treatment. This is not observed following unimodal interventions. Conclusions The intervention should begin early in the clinical course of degenerative dementia in order to be able to sustain the person’s abilities at as high a level as possible for as long as possible. This is a chance for the future!