Nonpharmacological approaches to the care of dementia with lewy bodies

Nonpharmacological approaches to the care of people with dementia include a range of theoretical orientations and methodologies. Unlike pharmacological approaches, where the focus of treatment is on the diseased individual, nonpharmacological interventions focus treatment on the interactions between a person and the environment. While specific goals of treatment can also differ between the two approaches, both can be used to improve function or decrease behavioral problems. Nonpharmacological interventions have been used specifically to enhance cognition, affect and Activities of Daily Living (ADL) performance, to reinforce a positive sense of self, and to reduce agitation/behavioral problems and psychotic symptoms. Other targets have included decreasing the burden on caregivers or promoting independence. When examining which of these goals is worthwhile for a specific person in a specific situation, the importance of overarching goals, such as maximizing quality of life, needs to be examined. Before embarking on any treatment, the decision maker(s) need to clarify answers to such questions as: Who needs to be treated? Whose problem is being treated? Whose reality is being considered? Whose needs and preferences take precedence? Answers to these questions will determine the ultimate goal, which will then dictate the specific nonpharmacological method(s) to be used.