Non-Pharmacological Interventions for the Hallucinations in Patients with Dementia. A Cross-Over Randomized Controlled Trial.

OBJECTIVE

Hallucinations is a core characteristic symptom in Lewy Body Dementia (DLB) and Parkinson's Dementia (PDD). It may also appear at the late stages of Alzheimer's disease (AD). They are not easily managed, and they are associated with cognitive decline, earlier institutionalization, increased mortality, and increased caregivers' burden.

DESIGN/SETTING: This is a cross-over RCT. The participants were randomly assigned in 6 different groups of 10 patients each.

PARTICIPANTS

60 dementia patients (different types and stages of dementia).

INTERVENTIONS

The three non-pharmacological interventions used are: A) Validation therapy (VT) in a Psycho-educational program, B) Reminiscence therapy (RT) and C) Music therapy (MT). Each intervention lasted for 5 days and there was an interval of two days, as a wash-out period (all the interventions had a duration of 3 weeks).

MEASUREMENTS

The measurements which were used at baseline were: MMSE, ACE-R, GDS, FRSDD and NPI questionnaire at baseline and after each intervention.

RESULTS

The most effective combination for the reduction of the hallucinations is: VT/Psycho-educational program (p = 0.005), MT (p = 0.007) and RT (p = 0.022). The same combination applies for the caregivers' distress: VT/Psychoeducational program (p = 0.010) - MT (p = 0.023) - RT (p = 0.036).

CONCLUSION

VT/Psycho-educational program followed by MT, followed by RT is an effective combination of non-pharmacological interventions that can reduce hallucinations in patients with dementia and caregivers' burden. Non-pharmacological interventions should be further examined as an effective alternative for the reduction of the hallucinations in dementia.