Non-pharmacological treatment of Alzheimer disease dementia:its significance and practice

Haruyasu Yamaguchi

Gunma University Graduate School of Health Sciences

Core symptoms of the Alzheimer disease dementia (ADD) is not a simple cognitive decline.  Anosognosia, which is a difficulty in evaluating own ability properly, makes caregiver frustrated.  ADD removes self-esteem and social roles from the patient, and also destroys relationship between patient and caregiver.  Therefore, in the treatment of ADD, enhancing self-esteem and self-efficacy, giving patients daily roles, and re-constructing a good relationship between patient and his/her caregiver are important as non-pharmacological treatment.
The author proposed the Brain-activating rehabilitation (BAR), which enhance motivation and improve behavioral and psychological symptoms of dementia (BPSD).  The BAR consists of 5 principles:(i) enjoyable and comfortable activities in an accepting atmosphere;(ii) activities associated with empathetic two-way communication between the therapist and patient, as well as between patients;(iii) therapists should praise patients to enhance motivation;(iv) therapists should try to offer each patient some social role that takes advantage of his/her remaining abilities;and (v) the activities should be based on errorless learning to ensure a pleasant atmosphere and to maintain a patient's dignity.
In the treatment of BPSD, caregiver should feel how the patients feel, and act by keeping the patients feeling in the caregiver's mind.   In the person-centered care, psychological need of the patients:comfort, attachment, occupation, identity and inclusion;should be filled to prevent BPSD.  Humanitude is a care technique, which is filled with humanity and love.  Watching, talking, touching and standing are core 4 techniques of the Humanitude.

Address correspondence to Dr. Haruyasu Yamaguchi, Gunma University Graduate School of Health Sciences (3-39-22 Showa-machi, Maebashi, Gunma 371-8514, Japan)