Reality orientation therapy combined with cholinesterase inhibitors in Alzheimer's disease: Randomised controlled trial

Abstract

Background: Reality orientation therapy combined with cholinesterase inhibitors has not been evaluated in patients with Alzheimers disease. Aims: To perform such an evaluation. Method: We randomly assigned 79 of 156 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 Alzheimers Disease Assessment Scale - Cognition (treatment group mean change +0.4, s.e.=0.8; control group -2.5, s.e.=0.8; P=001). The intervention had an equal effect on 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 Alzheimers disease.