What do Cochrane systematic reviews say about non-pharmacological interventions for treating cognitive decline and dementia?

Abstract

BACKGROUND: Dementia is a highly prevalent condition worldwide. Its chronic and progressive presentation has an impact on physical and psychosocial characteristics and on public healthcare. Our aim was to summarize evidence from Cochrane reviews on non-pharmacological treatments for cognitive disorders and dementia. DESIGN AND SETTING: Review of systematic reviews, conducted in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo. METHODS: Cochrane reviews on non-pharmacological interventions for cognitive dysfunctions and/or type of dementia were included. For this, independent assessments were made by two authors. RESULTS: Twenty-four reviews were included. These showed that carbohydrate intake and validation therapy may be beneficial for cognitive disorders. For dementia, there is a potential benefit from physical activity programs, cognitive training, psychological treatments, aromatherapy, light therapy, cognitive rehabilitation, cognitive stimulation, hyperbaric oxygen therapy in association with donepezil, functional analysis, reminiscence therapy, transcutaneous electrical stimulation, structured decision-making on feeding options, case management approaches, interventions by non-specialist healthcare workers and specialized care units. No benefits were found in relation to enteral tube feeding, acupuncture, Snoezelen stimulation, respite care, palliative care team and interventions to prevent wandering behavior. CONCLUSION: Many non-pharmacological interventions for patients with cognitive impairment and dementia have been studied and potential benefits have been shown. However, the strength of evidence derived from these studies was considered low overall, due to the methodological limitations of the primary studies. RESUMO INTRODUÇÃO:Demência é uma condição com alta prevalência e incidência global. Sua característica crônica e progressiva tem impacto em aspectos físicos, psicossociais e na saúde pública. Nosso objetivo foi resumir evidências de revisões Cochrane sobre intervenções não farmacológicas para distúrbios cognitivos e demências. TIPO DE ESTUDO E LOCAL: Revisão de revisões sistemáticas conduzida na Disciplina de Medicina Baseada em Evidências da Escola Paulista de Medicina, Universidade Federal de São Paulo. MÉTODOS: Foram incluídas revisões Cochrane sobre intervenções não farmacológicas para disfunções cognitivas e/ou qualquer tipo de demência, após a avaliação realizada de forma independente por dois autores. RESULTADOS: Vinte e quatro revisões foram incluídas. As revisões mostraram que ingestão de carboidratos e a terapia de validação podem ser benéficas para distúrbios cognitivos. Para demência, existe benefício potencial de programas de atividade física, treino cognitivo, tratamentos psicológicos, aromaterapia, terapia com luz, reabilitação cognitiva, estimulação cognitiva, oxigenoterapia hiperbárica associada a donepezila, análise funcional, terapia de reminiscência, estimulação elétrica transcutânea, decisão estruturada em op...

The Effectiveness of Non‐Pharmacological Interventions on Apathy in Patients With Dementia: A Systematic Review of Systematic Reviews

“…Currently, non-pharmacological interventions have become preferable options to deal with apathy due to the limited Key words dementia, apathy, non-pharmacological intervention, systematic review of systematic reviews efficacy and adverse effects of pharmacological therapies (Seitz et al, 2012). Two systematic reviews of systematic reviews (Abraha et al, 2017;Vilela, Pacheco, Latorraca, Pachito, & Riera, 2017) reveal that non-pharmacological interventions have positive effects on reducing BPSD, improving cognitive function, activities of daily living, and social interaction ability of patients with dementia. For apathy, there are several systematic reviews and meta-analyses (Brodaty & Burns, 2012;Fukushima et al, 2016;Goris, Ansel, & Schutte, 2016;Lane-Brown & Tate, 2009;Theleritis, Siarkos, Katirtzoglou, & Politis, 2016;Theleritis, Siarkos, Politis, Katirtzoglou, & Politis, 2018;Tsoi et al, 2018;Verkaik, Weert, & Francke, 2005;Zafra-Tanaka, Pacheco-Barrios, Tellez, & Taype-Rondan, 2019) of non-pharmacological interventions in patients with dementia.…”

Effects of moxibustion on symptoms of mild cognitive impairment: protocol of a systematic review and meta-analysis

“…10 11 Non-pharmacological interventions, such as physical activity programmes, cognitive rehabilitation, psychological treatments, aromatherapy and light therapy have been attempted as well. 12 However, evidence as to the efficacy and safety of these therapies is limited.…”

Review of Programs for Persons Facing Death with Dementia

“…The effectiveness of Snoezelen therapy is questionable. Although there are some positive results reported [35,37], a more recent study did not find any significant changes in agitation after Snoezelen use [38]. An ethnographic study of Snoezelen use found that equipment predominantly stimulates vision and touch, equipment is underused, and staff receive little training in how to facilitate sessions [34].…”