Comparison of the efficacy of gesture‐verbal treatment and doll therapy for managing neuropsychiatric symptoms in older patients with dementia

Abstract

Background The prevalence of neuropsychiatric symptoms (NPS) diminishes the quality of life and increases the care burden in patients with dementia. Despite the clinical importance of dementia‐associated NPS, no protocols for treating NPS are already well established. Attention has turned to the effectiveness of nonpharmacological treatments for NPS since their potential safe alternative to pharmacotherapy. Objective This study is aimed to compare the effects in older individuals with dementia living in a residential care, of two intervention programs, the gesture‐verbal treatment (GVT), a treatment implemented by us on a previous method for word retrieval in individuals with aphasia, and the better‐known doll therapy (DT). The GVT would act on both receptive and expressive language skills, the DT on attachment and emotional connections. Methods We evaluated NPS by the neuropsychiatric inventory in a total of 30 patients divided into 3 groups, the GVT, the DT, and control groups, using a pre‐post design. The treatment groups completed 12‐week nonpharmacological interventions in addition to standard rehabilitative therapies, while the control group participated only in standard rehabilitative therapies. Results The DT group showed significant improvements in agitation, irritability, apathy, depression, and delusions relative to controls. The GVT group showed significant improvements in apathy and depression with respect to controls. The DT intervention ameliorated symptoms of agitation compared to the GVT intervention whereas the GVT intervention improved apathy compared to the DT intervention. Conclusion Improved understanding of the potential therapeutic benefits of different treatments for neuropsychiatric symptoms is crucial for establishing nonpharmacological interventions in dementia.

The Effect of Doll Therapy on Agitation and Cognitive State in Institutionalized Patients With Moderate-to-Severe Dementia: A Randomized Controlled Study

“…Another study that compared the effectiveness of doll therapy and gesture-verbal therapy in managing the neuropsychiatric symptoms of patients with dementia found that doll therapy was more effective in managing agitation. 44 The same study found that, compared to the control group, the doll therapy intervention group displayed decreased levels of agitation, irritability, apathy, depression, and delusion. 44 In literature on the subject, the effects of doll therapy on patients with dementia have been attributed to attachment theory, 11,22 in which protection and safety are important for the individual, and the need for attachment may arise with the occurrence of insecurity or disease.…”

“…44 The same study found that, compared to the control group, the doll therapy intervention group displayed decreased levels of agitation, irritability, apathy, depression, and delusion. 44 In literature on the subject, the effects of doll therapy on patients with dementia have been attributed to attachment theory, 11,22 in which protection and safety are important for the individual, and the need for attachment may arise with the occurrence of insecurity or disease. 21,22 Accordingly, it is suggested that behavioral disturbances and agitation in patients with dementia demonstrate a craving for attachment, which is a psychological need.…”

The Doll Therapy as a First Line Treatment for Behavioral and Psychologic Symptoms of Dementia in Nursing Homes Residents: A Randomized, Controlled Study

“…The lack of solid scienti c evidences is mainly due to the di cult in standardization of nonpharmacologic intervention; as regards DT some attempt towards standardization have been done with well-designed randomized controlled clinical trials [20,[47][48][49]. The randomized-controlled clinical trials agree on the e cacy of DT in ameliorating BPSD in nursing home residents.…”

Narrative review: recent advances in doll therapy for Alzheimer’s disease

“…Some nondrug therapies, such as reminiscence therapy, music therapy, aromatherapy, and doll therapy (DT), have been shown to be effective in temporarily relieving or improving symptoms and enhancing the quality of life. Among them, DT has been widely investigated due to its simplicity and costeffectiveness (8)(9)(10)(11). Here, we review the studies related to the treatment of AD with DT, with an attempt to better understand the effectiveness and clinical applications of this nondrug therapy.…”

“…Cai et al performed a controlled trial in 186 AD patients and found 93 patients in the DT group showed significantly improved language, place judgment, memory, movement, and cognitive function compared to 93 patients in the control group (treated with conventional therapy). Balzotti et al (11) applied DT in 10 AD patients, and the DT group showed significant improvements in agitation, irritability, and other psychological symptoms relative to controls; the patients' interaction and familiarity with the dolls facilitated the formation of communication and attachment relationships, reduced behavioral and emotional disturbances, delayed the progression of the disease to a certain extent, and improved the cognitive function of patients.…”