Non-Pharmacological interventions for the delusions in patients with dementia. A cross-over RCT

Objectives: Delusional ideas include false beliefs, enduring, irrefutable, suspiciousness, misidentification, abandonment, etc. They do not only affect the caregivers’ burden but also increase the cognitive decline and can lead patients with dementia to fasterinstitutionalization and higher mortality. The current pharmacological treatment has serious side effects. The non-pharmacological interventions could be an effective alternative to reduce delusions and/ or caregivers’ distress because of the delusions of their dementia patients.

Methods / Design: The trial is a cross-over randomized controlled trial (RCT) conducted in Greece. Sixty (60) participants with several types and stages of dementia were randomly assigned to 6 different groups of 10 participants each. The three non-pharmacological interventions used are a) Validation therapy (VT) / Psycho-educational program, b) Reminiscence therapy (RT), and c) Music therapy (MT). The measurements used were MMSE, ACE-R, GDS, FRSSD, and NPI questionnaire (sub-questions for delusions). Each intervention lasted for 5 days and there was a two-day wash-out period. There was no drop-out rate.

Results: The most effective combination for patients’ and caregivers’ distress is Validation therapy/ Psychoeducational program (p=0.016)- MT (p=0.028)- RT (p=0.030).

Conclusions: There is an effective combination of non-pharmacological interventions that can reduce delusions in PwD and caregivers’ burden.

Keywords: Alzheimer’s disease, BPSD, psychosis, delusions, RCT, non-pharmacological, dementia