Reality orientation therapy combined with cholinesterase inhibitors in Alzheimer's disease: randomised controlled trial.
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.
Onder
Graziano
G
Department of Gerontology, Geriatrics and Psychiatry, Catholic University, Rome. graziano_onder@rm.unicatt.it
Zanetti
Orazio
O
Giacobini
Ezio
E
Frisoni
Giovanni B
GB
Bartorelli
Luisa
L
Carbone
Gabriele
G
Lambertucci
Paola
P
Silveri
Maria Caterina
MC
Bernabei
Roberto
R
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
D002800:Cholinesterase Inhibitors; D007189:Indans; D010880:Piperidines; D000077265:Donepezil