Non-pharmacological interventions for psychotic symptoms in people with dementia: a Delphi consensus

Background: Psychotic symptoms such as delusion and hallucinations are common in people with dementia. They are associated with various deleterious outcomes including reduced quality of life and increased caregiver burden. Pharmacological interventions to combat psychotic symptoms have shown limited efficacy and can be associated with significant adverse events. Non-pharmacological interventions are recommended as the first line option for treatment, however there is a paucity of evidence for specific non-pharmacological options to primarily target psychotic symptoms in people with dementia. Further work is needed to identify, adapt and develop possible non-pharmacological options to target psychotic symptoms in dementia. Aim: To establish which non-pharmacological interventions could be used or adapted to treat psychotic symptoms and/or confer benefits in people with dementia Design: Modified Delphi consensus process. Two rounds of feedback were conducted and included a directed scoping review, based on the interventions recommended in the first round of the Delphi. Participants: An expert panel consisted of 12 members with clinical and research expertise in managing psychotic symptoms in people with dementia Results: There were three top nominated treatment options: cognitive behavioural therapy (CBT), family intervention, and personalized activities/environmental/sensory interventions, without a clear priority between the 3 approaches. The WHELD/Brief Psychosocial Therapy programme focussing on personalized activities improves concurrent neuropsychiatric symptoms in people with dementia related psychosis. Preliminary studies also suggest that combining personalized activities with family training may improve the direct impact on psychosis. There are also opportunities to adapt CBT interventions for people with psychosis related to early or mild dementia. Conclusions: There were clear recommendations for three non-pharmacological options that could be used or adapted to benefit people with psychosis in the context of dementia.