Reality orientation therapy to delay outcomes of progression in patients with dementia. A retrospective study.

Abstract

To evaluate the impact of continued Reality Orientation Therapy (ROT) in delaying the outcomes of dementia progression. Retrospective study. Data collection was based on review of clinical charts and on telephone interviews performed with patients or primary caregivers. Day hospital of the Alzheimer's Disease Unit, Brescia (Italy). Seventy-four patients enrolled in at least one cycle of ROT from 1994 to 1998 were studied. Rehabilitative intervention based on formal ROT. This study analysed the time to the occurrence of any of the following: cognitive decline on Mini-Mental State Examination scores, urinary incontinence as an index of functional decline, institutionalization, and death. Data on a 30-month period after the first ROT session were analysed. We compared 46 patients (treatment group) who completed from 2 to 10 ROT cycles (corresponding to 8-40 weeks of training; mean = 15.48) with 28 patients (control group) who completed only one ROT cycle (4 weeks). Treatment group showed higher estimated survival rates than control group on cognitive decline (p = 0.022) and institutionalization (p = 0.002). The relative risks for cognitive decline and institutionalization in the control group compared with treatment group were 0.60 (p = 0.014), and 0.42 (p = 0.021), respectively. Continued ROT classes during the early to middle stages of dementia may delay nursing home placement and slow down the progression of cognitive decline.