A counseling intervention for caregivers: effect on neuropsychiatric symptoms

In Thailand, family caregivers have an important role in delivering care to patients with dementia. Most patients with dementia in Thailand and also in Western societies live in the community. Training caregivers may improve care of dementia patients.

We performed a treatment study of a six-month caregiver intervention with group counseling and support with provision of techniques to cope with non-cognitive symptoms of patients with dementia. We hypothesized that this caregiver intervention with group counseling and support would reduce behavioral and neuropsychiatric symptoms in the demented patients.

We conducted a parallel group intervention study. A manual for group counseling and support was developed focusing on education regarding dementia, behavioral analysis and intervention, and environmental adaptation. Fifty nonprofessional caregivers-25 from the control group and 25 from the study group-of patients with dementia from the memory clinic at Siriraj Hospital were alternately assigned to each group as they presented to the clinic if they met the inclusion criteria and agreed to participate. The Thai Mental State Examination (TMSE) was used to assess dementia severity. Forty-five minute counseling sessions were conducted every 6-8 weeks for 6 months and assessments were conducted at 3 months and 6 months. The primary outcome measure was the Neuropsychiatric Inventory (NPI).

A paired samples analysis of the NPI scores demonstrated a significant change of the total NPI scores at the end of six month from baseline in the intervention group (P = 0.045). Change from baseline of the comparison group was not significant. There was a trend towards improvement of the TMSE scores between the two groups at month six (p = 0.061). The result favored the treatment group.

This study provided evidence of the utility of a non-pharmacologic intervention using group counseling in an out-patient setting for caregivers of patients with dementia.