The French experience with Cognitive and Behavioral management Units (CBUs)

Alzheimer’s disease and related disorders are characterized by cognitive impairment associated with behavioral and psychological symptoms of dementia. These symptoms have significant consequences for both the patient and his family environment. A CBU offers non-drug management of the crisis which occurs with Alzheimer’s disease and an individualized cognitive and behavioral rehabilitation program for an average of 41 days[1]. These units belong to hospital wards and the team is composed by pluridisciplinary professionals The architecture is adapted for the type of care these patients need.

CBUs are considered as one of the important achievements of the past ten years in Alzheimer disease management in France. Each CBU is different although they all refer to national guidelines.

1/ Admission criteria in CBU:

Patients with Alzheimer’s disease or related dementia, with both sufficient mobility (so as the patient is able to participate to the proposed activities) and behavior disorders (aggressiveness, hallucination, agitation, sleeping disorders …)

2/ Nature of the care provided:

In basic CBU premises, a structured and adapted activity program, centered on non-drug measures, has shown to reduce the disorders and the expression of SPCDs by 20%, and subsequently decrease of the need to use of psychotics drugs and measures of physical restraint, the implementation of compensatory strategies for deficits, the preventive care of a crisis situation. Preservation, even improvement of the adaptation to the acts of the everyday life, is observed.

This program is based on French and international recommendations on disruptive behavioral disorders, stating that medications by psychotropic drugs should only be used in cases of failure of relational, environmental, and non-pharmacological care.

3/ Human ressources

The staff has been increased in number (compared with other non-specialized reeducation units) and has been specifically trained to give priority to relational care. In addition, a psychologist is dedicated to the unit. This allows a reassuring support and human presence.

Besides the usual staffs of the care and rehabilitation services, dedicated and formed professionals are needed, at least: experienced or trained physicians, psychologist,  professionals of reeducation (occupational therapists, psychomotor therapists). The intervention of other professionals is advisable (speech therapist, dietitian, music therapist …)

4/ CBU Premises

CBU premises should comprise: 1) a technical platform for rehabilitation in the acts of current life and platform of cognitive rehabilitation, 2) Single bedrooms, 3)  walking areas, 4) common life and activity room

6/  For clarification purposes, CBU are neither psychiatry departments, nor diagnostic units or reinforced units for people suffering from chronic behaviour disorders

7/ Main challenges include

            - severe stage of disorders, bedridden invalid persons

            - density of men with behavioral disorders

            - social issues which increase the length of stay in CBU

            - small size of the team with increased risks of exhaustion

8/ Impact assessment

Although CBU are generally recognised as very useful for the management of Alzheimer patient, demonstrating the effectiveness of non-pharmacological measures remains challenging. The necessity to find new adapted methodologies to evaluate non pharmacological measures was highlighted in the non-degenerative diseases plan 2014-2019 and remains one essential need in the next years.

[1] According to a survey (2019)