Psychological Interventions for Neuropsychiatric Disturbances in Mild and Moderate Alzheimer's Disease: Current Evidences and Future Directions.

Abstract

The occurrence of the neuropsychiatric disturbances is common feature in dementia. Nonpharmacological interventions are the first approach to manage these symptoms. We reviewed the available literature data on psychological interventions for neuropsychiatric disturbances in Alzheimer's disease (AD) focusing on the significant impact on people with dementia and their caregivers. Reminiscence interventions showed evidences of an improvement in cognition and mood in people with dementia as well as a decrease in caregiver burden. Reality orientation therapy was related to an increase in cognition, a decrease in dysfunctional behaviors and a reduced risk of institutionalization among people with AD. However, the potential benefits need a continued program. Cognitive stimulation therapy showed improvement on the functional ability and decrease negative emotional symptoms, when combined with acetylcholinesterase inhibitor. Studies based on behavioral approaches found a significant reduction in disruptive behaviors following intervention, agitated speech, a reduction in entry into a restricted area and a reduction in wandering frequency across participants. There is evidence that only multicomponent interventions can decrease caregivers' psychological morbidity and reduce their burden. The challenge for future research in psychological approaches in dementia is related to the need of larger and high quality evidence-base studies with well define outcomes aiming their effectiveness through a well-design protocol to evaluate their benefits.