Summary

Brief Psychosocial Therapy, consisting primarily of social interactions, was associated with significant improvement in agitation in patients with Alzheimer’s disease.

Design

• N=318 patients with Alzheimer’s disease with agitated behavior treated with brief psychosocial therapy (BPST), in an open design.
• BPST lasted 4 weeks, and involved social interaction, removal of environmental triggers, and personalized music. Treatments were tailored to the needs of the individual, but social interaction was the preferred modality.
• Setting: eight clinical centers in England, 2003-2005.
• Primary outcome: Cohen-Mansfield Agitation Inventory (CMAI) score, a 29-item scale assessing physically and verbally aggressive behaviors, and physically nonaggressive behavior.
• This intervention was the first part of the Cholinesterase Inhibitor and Atypical Neuroleptic in the Management of Agitation in Alzheimer Disease (CALM-AD) study. The 4-week BPST intervention was followed by pharmacotherapy in the next phase.

Results

• Participants showed an improvement of 5.6 points on the CMAI scale (P<0.0001):
  • Baseline: 63.3 (SD=16.0)
  • 4 Weeks: 57.7 (SD=18.4)
• Significant improvement, defined conventionally as 30% improvement in neuropsychiatric symptoms, was achieved in 43% of participants.
• Level of improvement did not differ significantly between those with longstanding agitation (more than 12 months) and those with agitation of shorter duration.
• The authors acknowledge that while improvement in agitation was significant, the open-label nature of this phase of the CALM-AD study makes it difficult separate direct effects from therapy from Hawthorne effects and spontaneous improvement.

Reference

Clive Ballard M R C Psych MD, D RBP, Sc JFM, et al. Brief Psychosocial Therapy for the Treatment of Agitation in Alzheimer Disease (The CALM-AD Trial). American Journal of Geriatric Psychiatry. 2012;17(9):726-733. doi:10.1097/JGP.0b013e3181b0f8c0.