title: Reality orientation therapy combined with cholinesterase inhibitors in Alzheimer's disease: randomised controlled trial.
abstract: BACKGROUND
  Reality orientation therapy combined with cholinesterase inhibitors has not been evaluated in patients with Alzheimer's disease.
  
  
  OBJECTIVE
  To perform such an evaluation.
  
  
  METHODS
  We randomly assigned 79 of 156 patients treated with donepezil to receive a reality orientation programme. Caregivers of the treatment group were trained to offer the programme at home 3 days a week, 30 min/day, for 25 consecutive weeks, and were invited to stimulate and involve patients in reality-based communication.
  
  
  RESULTS
  The treatment group showed a slight improvement in Mini-Mental State Examination (MMSE) scores (mean change +0.2, s.e.=0.4) compared with a decline in the control group (mean change -1.1, s.e.=0.4; P=0.02). Similarly for the Alzheimer's Disease Assessment Scale--Cognition (treatment group mean change +0.4, s.e.=0.8; control group -2.5, s.e.=0.8; P=0.01). The intervention had an equal effect on cognition in those with mild (MMSE score > or = 20) and moderate (score <20) dementia. No significant effect was observed for behavioural and functional outcomes.
  
  
  CONCLUSIONS
  Reality orientation enhances the effects of donepezil on cognition in Alzheimer's disease.
authors.affiliation: Department of Gerontology, Geriatrics and Psychiatry, Catholic University, Rome. graziano_onder@rm.unicatt.it
authors.forename: Graziano
authors.initials: G
authors.lastname: Onder
authors.forename: Orazio
authors.initials: O
authors.lastname: Zanetti
authors.forename: Ezio
authors.initials: E
authors.lastname: Giacobini
authors.forename: Giovanni B
authors.initials: GB
authors.lastname: Frisoni
authors.forename: Luisa
authors.initials: L
authors.lastname: Bartorelli
authors.forename: Gabriele
authors.initials: G
authors.lastname: Carbone
authors.forename: Paola
authors.initials: P
authors.lastname: Lambertucci
authors.forename: Maria Caterina
authors.initials: MC
authors.lastname: Silveri
authors.forename: Roberto
authors.initials: R
authors.lastname: Bernabei
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000188:drug therapy / Q000628:therapy*; D017028:Caregivers / Q000193:education / Q000523:psychology; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D003071:Cognition; D003131:Combined Modality Therapy; D000077265:Donepezil; D005260:Female; D006801:Humans; D007189:Indans / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010880:Piperidines / Q000627:therapeutic use*; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D011937:Reality Therapy / Q000193:education; D016896:Treatment Outcome
chemical_list: D002800:Cholinesterase Inhibitors; D007189:Indans; D010880:Piperidines; D000077265:Donepezil