Person-Centered Approach: A Potential Therapeutic Alternative for Patients with Frontotemporal Dementia (pp. 15-33)
Authors: (Osamu Yokota, Yoshikatsu Fujisawa and Ken Sasaki)
Abstract: Patients with dementia frequently show behaviors that distress caregivers, such as aggression, restlessness, delusion, and wandering. Clinicians have tried to manage the behavioral symptoms by using diverse psychotropic drugs, and recently, atypical antipsychotics. However, several recent studies demonstrated that efficacy of neuroleptic treatment on behavioral symptoms in dementia may be more modest than that believed previously. Furthermore, in 2005, the U.S. Food and Drug Administration (FDA) warned that the use of atypical antipsychotics increased the risk of death in patients with dementia. Therefore, in long-term care practice, safer and more effective alternative interventions to manage behavioral symptoms are keenly needed. Patients with frontotemporal dementia (FTD), the second most common degenerative dementia in the presenium, usually exhibit remarkable behavioral symptoms including restlessness, rapid mood shift, behavioral stereotypy, social breakdown, personality change, and alteration of eating behavior. Therefore, FTD is thought to be one of the most difficult diseases to cope with in diverse long-term care settings. Despite this, non-pharmacological
intervention on FTD patients has hardly been investigated. In this paper, we present the potential effects of person-centered care on behavioral symptoms, quality of life (QOL), and psychotropic drug use in FTD patients. Eight patients with FTD were relocated from a traditional ward in a psychiatric hospital to a group home in this study. They were evaluated for six months by using the Cohen-Mansfield Agitation Inventory (CMAI), the Dementia Behavior Disturbance Scale (DBD), the Neuropsychiatric Inventory (NPI), and the Health-Related Quality of Life Questionnaire for Dementia (QOL-D). The dose of psychotropic drugs prescribed was evaluated retrospectively. At the end of the 6-month study period, the NPI total score and CMAI total score were significantly improved compared with the baseline. The QOL-D subscale scores, including positive affect, restlessness, and attachment to others, were significantly improved at 6 months. The number of psychotropic drugs and the chlorpromazine-equivalent mean dose of antipsychotics decreased gradually and finally withdrawn. These findings support the possibility that person-centered care may have beneficial effects on behavioral symptoms, QOL, and psychotropic drug use in patients with FTD. We consider that the present findings have significant implications for the management of behavioral symptoms in FTD patients in diverse care settings, including group homes.