Psychotherapy and psychosocial interventions in dementia

Psychosocial interventions for dementing disorders have been developed from several clinical and theoretical backgrounds and for several clinical purposes. Mostly, psychotherapy (PT) and cognitive behavior therapy (CBT) have been applied for symptoms of depression, anxiety, and agitation. These approaches are used for milder forms of dementia or cognitive impairment, where awareness of deficits, therapy motivation and available cognitive ressources are sufficient to support personal or behavioral change. Group therapy approaches seem to be as effective as single patient settings. Interventions derived directly from clinical work with demented patients have been developed for cognitive, emotional and behavioral symptoms. Several trials, albeit of mixed quality suggest their usefulness in routine clinical care. These interventions adress the whole range of dementia stages, are highly flexible and can be tailored to individual patients. A number of behaviour modification techniques have been applied to demented patients with behavioural disturbance of advanced dementia, mostly in single case designs with highly individualized treatment plans. Given small effect sizes of single interventions, more evidence particularly on the effects of combined psychosocial (and pharmacological) interventions is required.