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The British Journal of Psychiatry (2005) 187: 450-455
© 2005 The Royal College of Psychiatrists

Reality orientation therapy combined with cholinesterase inhibitors in Alzheimer’s disease: randomised controlled trial

GRAZIANO ONDER, MD, PhD

Department of Gerontology, Geriatrics and Psychiatry, Catholic University, Rome

ORAZIO ZANETTI, MD

Alzheimer Evaluation Unit, IRCCS San Giovanni di Dio, Fatebenefratelli, Brescia, Italy

EZIO GIACOBINI, MD

University Hospital of Geriatrics, Geneva, Switzerland

GIOVANNI B. FRISONI, MD

Laboratory of Epidemiology and Neuroimaging, IRCCS San Giovanni di Dio, Brescia and Fatebenefratelli Research Association, Rome

LUISA BARTORELLI, MD

Geriatric Department, Hospital San Eugenio, Rome

GABRIELE CARBONE, MD

Alzheimer Evaluation Unit, Institute of Neurological and Psychiatric Sciences, Rome

PAOLA LAMBERTUCCI, PhD, MARIA CATERINA SILVERI, MD and ROBERTO BERNABEI, MD

Department of Gerontology, Geriatrics and Psychiatry, Catholic University, Rome, Italy

Correspondence: Graziano Onder, Centro Medicina dell’Invecchiamento, Università Cattolica del Sacro Cuore, L.go Francesco Vito 1, 00168 Roma, Italy. Tel: +39 06 30154341; fax: +39 06 3051911; e-mail: graziano_onder{at}rm.unicatt.it

Declaration of interest O.Z. is on the speaker bureau of Pfizer, Novartis, Janssen-Cilag and Bracco; R.B. has received honoraria from Pfizer. Funding from the Italian Ministry of Health.

Background Reality orientation therapy combined with cholinesterase inhibitors has not been evaluated in patients with Alzheimer’s disease.

Aims To perform such an evaluation.

Method We randomly assigned 79 of156 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 effecton cognition in those with mild (MMSE score ≥ 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.


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