Abstract
Introduction: Neuropsychiatric symptoms (NPS) are observed in over 90% of patients with vascular dementia (VaD) and represent a critical factor in the deterioration of the quality of life for both patients and their caregivers. The high risk of adverse effects from antipsychotics in this patient population often limits traditional pharmacotherapy.
Objective: The aim of this study was to enhance the effectiveness of treating neuropsychiatric symptoms (NPS) in vascular dementia (VaD) by implementing a comprehensive model that combines standard therapy with differentiated non-pharmacological correction, taking into account the prognostic significance of individual symptoms.
Methods: To achieve this goal, 65 patients with NPS in VaD were examined between 2019 and 2023. Study participants were divided into two groups: Intervention Group 1 (IG-1, n=34), which received standard therapy and a comprehensive intervention model (psychoeducation + differentiated correction), and Intervention Group 2 (IG-2, n=31), which received standard therapy (treatment as usual) as prescribed by the attending physician. The severity of dementia was assessed using the MMSE and MoCA scales, while NPS were evaluated using the Neuropsychiatric Inventory (NPI). Psychometric testing was conducted at three time points: at baseline (before treatment), and after 1 and 6 months. The proposed approach involved differentiated non-pharmacological correction of the most prognostically unfavorable symptoms, such as anxiety, disinhibition, sleep disturbances, and delusional ideas. The comprehensive intervention model included five structured sessions, lasting 40–50 minutes each, combining theoretical information with practical training in caregiving skills. The program covered the basics of psychoeducation on the nature of vascular dementia, methods for responding to behavioral disorders, sleep hygiene principles, and the implementation of individualized physical and cognitive activity plans for patients.
Results: No statistically significant difference between the groups was found after 1 month of treatment. However, after 6 months, IG-1 showed significantly better results than IG-2 (median NPI 44.0 vs. 55.0 in IG-2; p=0.0001). A positive trend in symptom reduction was observed in IG-1 between the 1st and 6th months (p=0.0446), whereas in the standard therapy group, the condition stabilized without further improvement (IG-2, p=0.1097).
Conclusions: The implementation of a comprehensive psychosocial rehabilitation model and differentiated non-pharmacological correction is significantly more effective for the long-term management of NPS in vascular dementia compared to isolated standard therapy. This approach reduces the pharmacological burden and improves the prognosis of VaD progression by actively involving caregivers and modifying the patient’s living environment.