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18 Interventions in Alzheimer’s Disease KCE Reports 111 Thompson CA, Spilsbury K, Hall J, Birks Y, Barnes C, Adamson J. Systematic review of information and support interventions for caregivers of people with dementia. BMC Geriatr. 2007;7:18. Robinson L, Hutchings D, Corner L, Beyer F, Dickinson H, Vanoli A, et al. A systematic literature review of the effectiveness of non-pharmacological interventions to prevent wandering in dementia and evaluation of the ethical implications and acceptability of their use. Health Technol Assess. 2006;10(26):iii, ix- 108. Viggo Hansen N, Jorgensen T, Ortenblad L. Massage and touch for dementia. Cochrane Database Syst Rev. 2006(4):CD004989. Smits CH, de Lange J, Droes RM, Meiland F, Vernooij-Dassen M, Pot AM. Effects of combined intervention programmes for people with dementia living at home and their caregivers: a systematic review. Int J Geriatr Psychiatry. 2007;22(12):1181-93. SBU. Dementia – Caring, Ethics, Ethnical and Economical Aspects. A systematic review. Volume 3. June 2008. Sitzer DI, Twamley EW, Jeste DV. Cognitive training in Alzheimer's disease: a metaanalysis of the literature. Acta Psychiatr Scand. 2006;114(2):75-90. Kuske B, Hanns S, Luck T, Angermeyer MC, Behrens J, Riedel-Heller SG. Nursing home staff training in dementia care: a systematic review of evaluated programs. Int Psychogeriatr. 2007;19(5):818-41. Selwood A, Johnston K, Katona C, Lyketsos C, Livingston G. Systematic review of the effect of psychological interventions on family caregivers of people with dementia. J Affect Disord. 2007;101(1-3):75-89. McGonigal-Kenny ML, Schutte DL. Nonpharmacologic management of agitated behaviors in persons with Alzheimer disease and other chronic dementing conditions. J Gerontol Nurs. 2006;32(2):9-14. Woods B, Spector A, Jones C, Orrell M, Davies S. Reminiscence therapy for dementia. Cochrane Database Syst Rev. 2005(2):CD001120. Livingston G, Johnston K, Katona C, Paton J, Lyketsos CG, Old Age Task Force of the World Federation of Biological P. Systematic review of psychological approaches to the management of neuropsychiatric symptoms of dementia. Am J Psychiatry. 2005;162(11):1996-2021. Verkaik R, van Weert JC, Francke AL. The effects of psychosocial methods on depressed, aggressive and apathetic behaviors of people with dementia: a systematic review. Int J Geriatr Psychiatry. 2005;20(4):301-14. Frank W, Konta B. Congitive training in dementia and other disorders with cognitive deficits. Köln: DAHTA-DIMDI; 2005. HTA Berichte (26) Available from: www.dimdi.de Sung H-C, Chang AM. Use of preferred music to decrease agitated behaviours in older people with dementia: a review of the literature. J Clin Nurs. 2005;14(9):1133- 40. Cameron M, Lonergan E, Lee H. Transcutaneous electrical nerve stimulation (TENS) for dementia. Cochrane Database Syst Rev. 2003(3):CD004032. Bharucha A, Anand V, Forlizzi J, Dew M, Reynolds Cr, Stevens S, et al. Intelligent Assistive Technology Applications to Dementia Care: Current Capabilities, Limitations, and Future Challenges. Am J Geriatr Psychiatry. 2008 Cooper C, Balamurali TBS, Selwood A, Livingston G. A systematic review of intervention studies about anxiety in caregivers of people with dementia. Int J Geriatr Psychiatry. 2007;22(3):181-8. Watson R, Green SM. Feeding and dementia: a systematic literature review. J Adv October 2005 Not included, as more recent SR available July 2005 February 2005 2005 December 2004 December 2004 July 2003 No systematic review (excluded) May 2004 July 2003 February 2003 2004? ? December 2002 2007? June 2005 December 2003
KCE Reports 111 Interventions in Alzheimer’s Disease 19 Nurs. 2006;54(1):86-93. Nguyen Q-A, Paton C. The use of aromatherapy to treat behavioural problems in dementia. Int J Geriatr Psychiatry. 2008;23(4):337-46. March 2007 3.2 REVIEWS OF NON-PHARMACOLOGICAL INTERVENTIONS 3.2.1 Introduction A systematic review of a very broad range of psychological approaches to the management of neuropsychiatric symptoms of dementia was published by the Old Age Task Force of the World Federation of Biological Psychiatry. 5 The SBU health technology assessment report covering various aspects of dementia, also includes a systematic review of care interventions. 21 Many studies reviewed in this HTA were rejected because of lack of adequate diagnoses. 21 The reason suggested could be the lack of involvement of a physician in many studies. Other important large reviews are the NICE 1 and the DIMDI report 28 , and several Cochrane reviews. These main reviews, as well as others will be discussed below, and the level of evidence supporting the various interventions will be mentioned. Interventions may target the patient, the caregiver or both. Likewise outcomes of these interventions may be assessed in patients, caregivers or both. Outcome parameters vary a lot between studies. Whereas some reviews focus specifically on the type of interventions, other reviews focus on a specific symptom or cluster of symptoms (mostly behavioral problems e.g. agitation, aggression, wandering) and consider the different interventions to improve it. Further, different authors tend to group the studies in different ways, illustrating the lack of standardization of interventions in this research area and also illustrating the many variations and combinations of interventions that are evaluated in the studies. The fact that few studies addressed the same issues in comparable ways is a major methodological problem, limiting the level of evidence which can be associated with such unique interventions. In the next paragraphs, we will describe: • Interventions addressing the patient o studies focusing on specific interventions : interventions addressing patient cognition, patient emotion, patient sensory enhancement; physical activity interventions; communication/interaction/relationship interventions; environmental adaptations o studies focusing on signs and symptoms: non-pharmacological interventions for challenging behavior, neuropsychiatric symptoms and wandering o studies focusing on technological support • Interventions that include the caregiver o Staff education: effects on patients or caregivers o Psychoeducation/psychosocial interventions for informal caregivers: effects on patients or caregivers o Respite care and special care units: effects on informal caregiver depression and stress o Interventions to delay institutionalization o Miscellaneous
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