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Brief psychosocial therapy for the treatment of agitation in Alzheimer disease (the CALM-AD trial)

Ballard, Clive, Brown, Richard, Fossey, Jane, Douglas, Simon, Bradley, Paul, Hancock, Judith, James, Ian A, Juszczak, Edmund, Bentham, Peter, Burns, Alistair, Lindesay, James, Jacoby, Robin, O'Brien, John, Bullock, Roger, Johnson, Tony, Holmes, Clive and Howard, Robert (2009) Brief psychosocial therapy for the treatment of agitation in Alzheimer disease (the CALM-AD trial) American Journal of Geriatric Psychiatry, 17, (9), pp. 726-33. (doi:10.1097/JGP.0b013e3181b0f8c0). (PMID:19700946).

Record type: Article


Background: good practice guidelines state that a psychological intervention should usually precede pharmacotherapy, but there are no data evaluating the feasibility of psychological interventions used in this way.

Methods: at the first stage of a randomized blinded placebo-controlled trial, 318 patients with Alzheimer disease (AD) with clinically significant agitated behavior were treated in an open design with a psychological intervention (brief psychosocial therapy [BPST]) for 4 weeks, preceding randomization to pharmacotherapy. The therapy involved social interaction, personalized music, or removal of environmental triggers.

Results: overall, 318 patients with AD completed BPST with an improvement of 5.6 points on the total Cohen-Mansfield Agitation Inventory (CMAI; mean [SD], 63.3 [16.0] to 57.7 [18.4], t = 4.8, df = 317, p < 0.0001). Therapy worksheets were completed in six of the eight centers, with the key elements of the intervention delivered according to the manual for >95% of patients. More detailed evaluation of outcome was completed for the 198 patients with AD from these centers, who experienced a mean improvement of 6.6 points on the total CMAI (mean [SD], 62.2 [14.3] to 55.6 [15.8], t = 6.5, df = 197, p < 0.0001). Overall, 43% of participants achieved a 30% improvement in their level of agitation.

Conclusion: the specific attributable benefits of BPST cannot be determined from an open trial. However, the BPST therapy was feasible and was successfully delivered according to an operationalized manual. The encouraging outcome indicates the need for a randomized controlled trial of BPST.

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Published date: September 2009


Local EPrints ID: 152271
PURE UUID: 71592d79-881a-4b84-9f72-c1905dd9e758

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Date deposited: 14 May 2010 09:03
Last modified: 18 Jul 2017 12:54

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Author: Clive Ballard
Author: Richard Brown
Author: Jane Fossey
Author: Simon Douglas
Author: Paul Bradley
Author: Judith Hancock
Author: Ian A James
Author: Edmund Juszczak
Author: Peter Bentham
Author: Alistair Burns
Author: James Lindesay
Author: Robin Jacoby
Author: John O'Brien
Author: Roger Bullock
Author: Tony Johnson
Author: Clive Holmes
Author: Robert Howard

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