Non-pharmacological interventions in dementia Mitchell.G.J.(1987)An Analysis of the Communication Process 2 Pharmacological treatments of dementia: and Content with Confused Elderly Clients during Validation Therapy.MA Thesis.Toronto:University of Toronto.School a can have many unwanted side-effects of Nursing. b are usually well prescribed and monitored Moniz-Cook.E,Agar.S..Silver,M..etal(1998)Can staff training c are used excessively in many care facilities reduce behavioural problems in residential care for the elderly d should not be used in treatment of BPSD mentally ill?International Journal of Geriatric Psychiatry,13 currently include the common use of neuroleptics to 149-158. Neal,M.&Briggs.M.(2002)Validation therapy for dementia. treat non-cognitive symptoms Cochrane Library,issue 3.Oxford:Update Software. O'Donovan,S.(1993)The memory lingers on.Elderly Care.5. 3 When discussing non-cognitive symptoms of 27-31. dementia: Perrin.T.(1998)Lifted into a world of rhythm and melody. Journal of Dementia Care.6.22-24. a memory problems and language disorders are Schultz.R.Williamson.G.H.(1991)A 2-year longitudinal common non-cognitive symptoms of dementia study of depression among Alzheimer's caregivers b the terms behavioural and psychological symp- Psychology and Aging.6,569-578. toms of dementia and challenging behaviours are Spector.A..Orrell,M.,Davies.S..et al (2001)Can reality synonymous orientation be rehabilitated?Development and piloting of one is solely talking about disruptive and agitated an evidence-based programme of cognition-based therapies for people with dementia.Neuropsychological Rehabilitation. behaviours 11,377-397. d neither psychological nor pharmacological treat- Spector,A..Orrell,M.,Davies,S..et al(2002a)Reality orientation ments seem to be effective for dementia.Cochrane Library,issue 3.Oxford:Update Software. e a non-pharmacological perspective would tend to Spector.A..Orrell,M..Davies,S.,et al (2002b)Reminiscence view a problematic behaviour as a manifestation of therapy for dementia.Cochrane Library,issue 3.Oxford: an underlying 'unmet'need. Update Software. Stokes,G.(2000)Challenging Behaviour in Dementia.Bicester: 4 A person with dementia: Speechmark. can be offered a number of different forms of non- Teri.L.Gallagher-Thompson,D.(1991)Cognitive- pharmacological intervention behavioural interventions for treatment of depression in Alzheimer's patients.Gerontologist,31.413-416. 6 can only be helped in the early stages of the dementia Van Diepen,E..Baillon,S.,Redman,J..et al (2002)A pilot C requires a moderate degree of intellectual insight in study of the physiological and behavioural effects of order to benefit from the non-pharmacological Snoezelen in dementia.British Journal of Occupational Therapy. treatments 65(2).61-66. Weissman,M..Markowitz.J.Klerman.G.(2000) d can be helped by unmet needs analysis.in which the Comprehensive Guide to Interpersonal Therapy.New York:Basic therapist identifies the patient's potential needs Books. e is unable to engage in the standard forms of Wiles,A.Brooker.D.(2003)Complementary therapies in psychotherapy (e.g.CBT.interpersonal therapy). dementia care.Journal of Dementia Care,11,31-36. Woods,R.T.(1999)Psychological Problems of Ageing.Chichester. John Wiley and Sons. 5 When employing non-pharmacological treatments: Young.A.Dinan,S.(1994)ABC of sports medicine.Fitness carers and/or staff should be willing to work/help for older people.BM/.309.331-334. with the treatment regimen b they should be used as an adjunct to pharmacological treatments Multiple choice questions c carers and/or staff may require both training and support in order to undertake the treatments 1 Non-pharmacological treatments for dementia: effectively a can be effective d improvements may occur across a range of abilities b should always be used as a second line of treatment (e.g.orientation,sleep,quality of life) to medication e one should always try to orient individuals with c aim to improve people's cognitive abilities dementia to what is happening in the present,so that d require the cooperation of staff they can engage in meaningful conversations and e are becoming increasingly well researched. interactions with others. MCQ answers 1 3 4 5 a T a T a F a T a T bF bF bF bF bF T cF c T d T dF dF dT dT e T e T eT e F e F Advances in Psychiatric Treatment(2004),vol.10.http://apt.rcpsych.org/ 177Non-pharmacological interventions in dementia Advances in Psychiatric Treatment (2004), vol. 10. http://apt.rcpsych.org/ 177 Mitchell, G. J. (1987) An Analysis of the Communication Process and Content with Confused Elderly Clients during Validation Therapy. MA Thesis. Toronto: University of Toronto, School of Nursing. Moniz-Cook, E., Agar, S., Silver, M., et al (1998) Can staff training reduce behavioural problems in residential care for the elderly mentally ill? International Journal of Geriatric Psychiatry, 13, 149–158. Neal, M. & Briggs, M. (2002) Validation therapy for dementia. Cochrane Library, issue 3. Oxford: Update Software. O’Donovan, S. (1993) The memory lingers on. Elderly Care, 5, 27–31. Perrin, T. (1998) Lifted into a world of rhythm and melody. Journal of Dementia Care, 6, 22–24. Schultz, R. & Williamson, G. H. (1991) A 2-year longitudinal study of depression among Alzheimer’s caregivers. Psychology and Aging, 6, 569–578. Spector, A., Orrell, M., Davies, S., et al (2001) Can reality orientation be rehabilitated? Development and piloting of an evidence-based programme of cognition-based therapies for people with dementia. Neuropsychological Rehabilitation, 11, 377–397. Spector, A., Orrell, M., Davies, S., et al (2002a) Reality orientation for dementia. Cochrane Library, issue 3. Oxford: Update Software. Spector, A., Orrell, M., Davies, S., et al (2002b) Reminiscence therapy for dementia. Cochrane Library, issue 3. Oxford: Update Software. Stokes, G. (2000) Challenging Behaviour in Dementia. Bicester: Speechmark. Teri, L. & Gallagher-Thompson, D. (1991) Cognitive– behavioural interventions for treatment of depression in Alzheimer’s patients. Gerontologist, 31, 413–416. Van Diepen, E., Baillon, S., Redman, J., et al (2002) A pilot study of the physiological and behavioural effects of Snoezelen in dementia. British Journal of Occupational Therapy, 65(2), 61–66. Weissman, M., Markowitz, J. & Klerman, G. (2000) Comprehensive Guide to Interpersonal Therapy. New York: Basic Books. Wiles, A. & Brooker, D. (2003) Complementary therapies in dementia care. Journal of Dementia Care, 11, 31–36. Woods, R. T. (1999) Psychological Problems of Ageing. Chichester: John Wiley and Sons. Young, A. & Dinan, S. (1994) ABC of sports medicine. Fitness for older people. BMJ, 309, 331–334. Multiple choice questions 1 Non-pharmacological treatments for dementia: a can be effective b should always be used as a second line of treatment to medication c aim to improve people’s cognitive abilities d require the cooperation of staff e are becoming increasingly well researched. MCQ answers 12345 aT aT aF aT aT bF bF bF bF bF cF cT cF cF cT dT dF dF dT dT eT eT eT eF eF 2 Pharmacological treatments of dementia: a can have many unwanted side-effects b are usually well prescribed and monitored c are used excessively in many care facilities d should not be used in treatment of BPSD e currently include the common use of neuroleptics to treat non-cognitive symptoms. 3 When discussing non-cognitive symptoms of dementia: a memory problems and language disorders are common non-cognitive symptoms of dementia b the terms behavioural and psychological symp￾toms of dementia and challenging behaviours are synonymous c one is solely talking about disruptive and agitated behaviours d neither psychological nor pharmacological treat￾ments seem to be effective e a non-pharmacological perspective would tend to view a problematic behaviour as a manifestation of an underlying ‘unmet’ need. 4 A person with dementia: a can be offered a number of different forms of non￾pharmacological intervention b can only be helped in the early stages of the dementia c requires a moderate degree of intellectual insight in order to benefit from the non-pharmacological treatments d can be helped by unmet needs analysis, in which the therapist identifies the patient’s potential needs e is unable to engage in the standard forms of psychotherapy (e.g. CBT, interpersonal therapy). 5 When employing non-pharmacological treatments: a carers and/or staff should be willing to work/help with the treatment regimen b they should be used as an adjunct to pharmacological treatments c carers and/or staff may require both training and support in order to undertake the treatments effectively d improvements may occur across a range of abilities (e.g. orientation, sleep, quality of life) e one should always try to orient individuals with dementia to what is happening in the present, so that they can engage in meaningful conversations and interactions with others