Dementia Collaborative Research Centre, School of Psychiatry, University of New South Wales, Sydney, Australia.
Am J Psychiatry. 2012 Sep;169(9):946-53. doi: 10.1176/appi.ajp.2012.11101529.
Behavioral and psychological symptoms are common in dementia, and they are especially stressful for family caregivers. Nonpharmacological (or psychosocial) interventions have been shown to be effective in managing behavioral and psychological symptoms, but mainly in institutional settings. The authors reviewed the effectiveness of community-based nonpharmacological interventions delivered through family caregivers.
Of 1,665 articles identified in a literature search, 23 included unique randomized or pseudorandomized nonpharmacological interventions with family caregivers and outcomes related to the frequency or severity of behavioral and psychological symptoms of dementia, caregiver reactions to these symptoms, or caregiver distress attributed to these symptoms. Studies were rated according to an evidence hierarchy for intervention research.
Nonpharmacological interventions were effective in reducing behavioral and psychological symptoms, with an overall effect size of 0.34 (95% CI=0.20-0.48; z=4.87; p<0.01), as well as in ameliorating caregiver reactions to these behaviors, with an overall effect size of 0.15 (95% CI=0.04-0.26; z=2.76; p=0.006).
Nonpharmacological interventions delivered by family caregivers have the potential to reduce the frequency and severity of behavioral and psychological symptoms of dementia, with effect sizes at least equaling those of pharmacotherapy, as well as to reduce caregivers' adverse reactions. The successful interventions identified included approximately nine to 12 sessions tailored to the needs of the person with dementia and the caregiver and were delivered individually in the home using multiple components over 3-6 months with periodic follow-up.
行为和心理症状在痴呆症中很常见，对家庭照顾者来说尤其具有压力。非药物干预（或心理社会干预）已被证明在管理行为和心理症状方面有效，但主要是在机构环境中。作者回顾了通过家庭照顾者实施的基于社区的非药物干预的有效性。
在文献检索中，共确定了 1665 篇文章，其中 23 篇文章包含了独特的随机或伪随机非药物干预措施，这些干预措施与家庭照顾者有关，与痴呆症患者行为和心理症状的频率或严重程度、照顾者对这些症状的反应、或归因于这些症状的照顾者痛苦有关。根据干预研究的证据等级对研究进行了评分。
非药物干预措施在降低行为和心理症状方面是有效的，总体效应量为 0.34（95%CI=0.20-0.48；z=4.87；p<0.01），同时也改善了照顾者对这些行为的反应，总体效应量为 0.15（95%CI=0.04-0.26；z=2.76；p=0.006）。
由家庭照顾者实施的非药物干预措施有可能降低痴呆症患者行为和心理症状的频率和严重程度，其效应大小至少与药物治疗相当，同时也能降低照顾者的不良反应。确定的成功干预措施包括大约 9 到 12 次针对痴呆症患者和照顾者需求的个性化家访，使用多种组件在 3-6 个月内分阶段进行，并定期随访。
