Nonpharmacological Therapies in Alzheimer’s Disease: A Systematic Review of Efficacy

• Published in: Dementia and geriatric cognitive disorders Vol. 30; no. 2; pp. 161 - 178
• Main Authors: Olazarán, Javier, Reisberg, Barry, Clare, Linda, Cruz, Isabel, Peña-Casanova, Jordi, del Ser, Teodoro, Woods, Bob, Beck, Cornelia, Auer, Stefanie, Lai, Claudia, Spector, Aimee, Fazio, Sam, Bond, John, Kivipelto, Miia, Brodaty, Henry, Rojo, José Manuel, Collins, Helen, Teri, Linda, Mittelman, Mary, Orrell, Martin, Feldman, Howard H., Muñiz, Ruben
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland Karger 01.01.2010; S. Karger AG
• Subjects: Activities of Daily Living - psychology; Aged; Alzheimer Disease - psychology; Alzheimer Disease - therapy; Biological and medical sciences; Caregivers - psychology; Cognitive Therapy; Complementary Therapies - psychology; Cost-Benefit Analysis; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Disease Progression; Evidence-Based Medicine; Humans; Institutionalization; Learning Curve; Medical sciences; Medicin och hälsovetenskap; Neurodegenerative Diseases - psychology; Neurodegenerative Diseases - therapy; Neurology; Quality of Life; Randomized Controlled Trials as Topic; Review Article; Systematic review; Treatment Outcome; Vascular diseases and vascular malformations of the nervous system; Alzheimer's disease, nonpharmacological therapy; Efficacy evaluation; Nervous system diseases; Treatment; Cognitive disorder; Alzheimer disease; Central nervous system disease; Degenerative disease; Cerebral disorder
• ISSN: 1420-8008; 1421-9824; 1421-9824
• DOI: 10.1159/000316119

Introduction: Nonpharmacological therapies (NPTs) can improve the quality of life (QoL) of people with Alzheimer’s disease (AD) and their carers. The objective of this study was to evaluate the best evidence on the effects of NPTs in AD and related disorders (ADRD) by performing a systematic review and meta-analysis of the entire field. Methods: Existing reviews and major electronic databases were searched for randomized controlled trials (RCTs). The deadline for study inclusion was September 15, 2008. Intervention categories and outcome domains were predefined by consensus. Two researchers working together detected 1,313 candidate studies of which 179 RCTs belonging to 26 intervention categories were selected. Cognitive deterioration had to be documented in all participants, and degenerative etiology (indicating dementia) had to be present or presumed in at least 80% of the subjects. Evidence tables, meta-analysis and summaries of results were elaborated by the first author and reviewed by author subgroups. Methods for rating level of evidence and grading practice recommendations were adapted from the Oxford Center for Evidence-Based Medicine. Results: Grade A treatment recommendation was achieved for institutionalization delay (multicomponent interventions for the caregiver, CG). Grade B recommendation was reached for the person with dementia (PWD) for: improvement in cognition (cognitive training, cognitive stimulation, multicomponent interventions for the PWD); activities of daily living (ADL) (ADL training, multicomponent interventions for the PWD); behavior (cognitive stimulation, multicomponent interventions for the PWD, behavioral interventions, professional CG training); mood (multicomponent interventions for the PWD); QoL (multicomponent interventions for PWD and CG) and restraint prevention (professional CG training); for the CG, grade B was also reached for: CG mood (CG education, CG support, multicomponent interventions for the CG); CG psychological well-being (cognitive stimulation, multicomponent interventions for the CG); CG QoL (multicomponent interventions for PWD and CG). Conclusion: NPTs emerge as a useful, versatile and potentially cost-effective approach to improve outcomes and QoL in ADRD for both the PWD and CG.