Behavioural interventions

Behavioural Interventions

Non-pharmacological therapies can be effective in treating the symptoms of dementia. They can help with both behavioural symptoms and memory problems. Non-pharmacological therapies can be an alternative or a supplement to other treatments (e.g: pharmacological treatments)

More than half of people with dementia have behavioural symptoms that affect their moods and behaviour

Some of the most common behavioural symptoms in people with dementia are:

  • Depression
  • Anxiety
  • Apathy
  • Hallucinations (visual or auditive)
  • Delusions
  • Restlessness or over-activity
  • Irritability or suspicion
  • Aggression (verbal or physical)
  • Loss of inhibitions (transgression of social conventions)

What causes behavioural symptoms?

Other than physical causes, two things are thought most likely to cause anxiety, distress, agitation and other changes in the behaviour of people with dementia:

  1. The damage in the brain that causes dementia may also cause the changes in behaviour. For example, if there is damage to the part of the brain that is responsible for working out what is appropriate behaviour, it may lead to ‘inappropriate’ behaviour, such as shouting, or strong emotions, such as anger.
  2. The person with dementia is trying to make sense of the world around them, but is reacting in a disorganised way. Most changes in behaviour are probably caused by a mixture of the two.

Strongly based on principles of learning theory, Behavioural Interventions (BI) use strategies aimed at suppressing or eliminating challenging behaviours.

In 1998 Moniz-Cook suggested that behavioural analysis is often the starting point of most other forms of therapeutic intervention in dementia. And modern behavioural approaches can be wholly consistent with person-centred care.

Emerson suggests focusing on three key features when designing an intervention:

  1. Taking account of the individual’s preferences
  2. Changing the context in which the behaviour takes place
  3. Using reinforcement strategies and schedules that reduce the behaviour

The efficacy of behavioural therapy has been demonstrated in the context of dementia in a small number of studies (Burgio & Fisher, 2000). For example, there is evidence of successful reductions in wandering, incontinence and other forms of stereotypical behaviours (Woods, 1999).

Either way behavioural interventions must be tailored to individual cases.