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S2‐01‐02: Working together: Combining pharmacological and psychosocial interventions for people with dementia and caregivers
Author(s) -
Brodaty Henry
Publication year - 2010
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2010.05.274
Subject(s) - dementia , psychosocial , apathy , psychological intervention , donepezil , context (archaeology) , distress , quality of life (healthcare) , psychiatry , medicine , psychology , cognition , randomized controlled trial , clinical psychology , caregiver burden , psychotherapist , disease , paleontology , surgery , pathology , biology
Background: There is robust evidence for pharmacotherapy and limited evidence for cognitive stimulation resulting in (modest) benefits for people with Alzheimer’s disease (AD) as regards cognition, function and behavior. There is also substantial literature demonstrating that psychosocial interventions directed at caregivers of people with dementia can reduce their depression and burden, and reduce patients’ behavioral symptoms and delay their entry into residential care. Evidence for combining these approaches is sparse despite most clinicians considering that such multi-modal approaches represent good practice Methods: This review describes randomized controlled trials of added benefits from combining pharmacotherapy and psychosocial interventions for people with dementia and their caregivers. Results: Counseling for caregivers of patients with AD, combined with donepezil, reduced caregiver depression and, in one context, patients’ rate of institutionalization. The outcomes of a collaborative care model were improvement in quality of care, behavioral and psychological symptoms of dementia and caregiver distress and depression. Cognitive stimulation for AD patients treated with donepezil resulted in less apathy and irritability and improvement in their discourse and functional abilities and selfreported quality of life. Other add-on interventions such as physical exercise, which can benefit cognition in older people without dementia, await good clinical trials. Conclusions: Emerging evidence points to the importance of broad multimodal strategies in planning therapy for people with dementia and their caregivers. Clinicians should consider prescribing cognitive (and possibly physical) exercises as well as medications for their patients combined with psychosocial therapies for their caregivers. Funding bodies and researchers should consider ways of building on experimental designs that neatly test individual interventions to evaluate real-life multi-modal interventions.