title: Non-pharmacological treatment reducing not only behavioral symptoms, but also psychotic symptoms of older adults with dementia: a prospective cohort study in Taiwan.
abstract: OBJECTIVE
  The clinical effectiveness of non-pharmacological interventions on behavioral and psychological symptoms of dementia (BPSD) among older Chinese with dementia remains unclear, and the evidence supporting the benefits of a non-pharmacological approach on psychotic symptoms is scarce.
  
  
  METHODS
  A prospective cohort study including 104 older men with dementia living in two veterans homes in Taiwan was carried out in 2011. An organized program of music therapy, orientation training, art-cognitive activities and physical activities was carried out for the intervention group. All participants were evaluated for neuropsychiatric inventory (NPI), defined daily dose of psychotropic drug use, Barthel Index, Instrumental Activities of Daily Living, Mini-Mental State Examination, Geriatric Depression Scale, Tinetti balance score and Tinetti gait score.
  
  
  RESULTS
  Overall, 104 residents were enrolled and 92 of them completed the study. The intervention group had a more significant reduction than the reference group in the overall NPI score (-2.36, P = 0.046), and in the subcategories of delusion (-0.9, P = 0.018), hallucination (-0.82, P = 0.004) and agitation (-0.91, P = 0.038). Multivariate analysis showed that the non-pharmacological intervention was associated with a favorable outcome in overall NPI score (OR 4.113, P = 0.013) and in the subcategories of hallucination (OR 14.309, P = 0.049) and agitation (OR 6.604, P = 0.037). Meanwhile, a higher baseline NPI score was also associated with a favorable outcome in overall NPI score, and in the subcategories of delusion, hallucination and agitation.
  
  
  CONCLUSIONS
  Non-pharmacological interventions have a positive effect on behavioral and psychological symptoms of dementia, not only in outward symptoms like agitation, but also intrinsic psychotic symptoms like hallucination and delusion, and agitation in older Chinese men with dementia.
authors.affiliation: Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan; Department of Family Medicine, Taipei City Hospital Zhonghsiao Branch, Taipei, Taiwan.
authors.forename: Rue-Chuan
authors.initials: RC
authors.lastname: Chen
authors.forename: Chien-Liang
authors.initials: CL
authors.lastname: Liu
authors.forename: Ming-Hsien
authors.initials: MH
authors.lastname: Lin
authors.forename: Li-Ning
authors.initials: LN
authors.lastname: Peng
authors.forename: Liang-Yu
authors.initials: LY
authors.lastname: Chen
authors.forename: Li-Kuo
authors.initials: LK
authors.lastname: Liu
authors.forename: Liang-Kung
authors.initials: LK
authors.lastname: Chen
mesh_terms: D000369:Aged, 80 and over; D044466:Asian People; D001526:Behavioral Symptoms / Q000209:etiology / Q000628:therapy*; D015331:Cohort Studies; D003704:Dementia / Q000628:therapy*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011618:Psychotic Disorders / Q000209:etiology / Q000628:therapy*; D013624:Taiwan
keywords: agitation; behavioral and psychiatric symptoms of dementia; delusion; dementia; hallucination; non-pharmacological interventions