Interventions to delay functional decline in people with dementia: a systematic review of systematic reviews

Abstract

ObjectiveTo summarise existing systematic reviews that assess the effects of non-pharmacological, pharmacological and alternative therapies on activities of daily living (ADL) function in people with dementia.DesignOverview of systematic reviews.MethodsA systematic search in the Cochrane Database of Systematic Reviews, DARE, Medline, EMBASE and PsycInfo in April 2015. Systematic reviews of randomised controlled trials conducted in people with Alzheimer's disease or dementia measuring the impact on ADL function were included. Methodological quality of the systematic reviews was independently assessed by two authors using the AMSTAR tool. The quality of evidence of the primary studies for each intervention was assessed using GRADE.ResultsA total of 23 systematic reviews were included in the overview. The quality of the reviews varied; however most (65%) scored 8/11 or more on the AMSTAR tool, indicating high quality. Interventions that were reported to be effective in minimising decline in ADL function were: exercise (6 studies, 289 participants, standardised mean difference (SMD) 0.68, 95% CI 0.08 to 1.27; GRADE: low), dyadic interventions (8 studies, 988 participants, SMD 0.37, 95% CI 0.05 to 0.69; GRADE: low) acetylcholinesterase inhibitors and memantine (12 studies, 4661 participants, donepezil 10 mg SMD 0.18, 95% CI 0.03 to 0.32; GRADE: moderate), selegiline (7 studies, 810 participants, SMD 0.27, 95% CI 0.13 to 0.41; GRADE: low), huperzine A (2 studies, 70 participants, SMD 1.48, 95% CI 0.95 to 2.02; GRADE: very low) and Ginkgo biloba (7 studies, 2530 participants, SMD 0.36, 95% CI 0.28 to 0.44; GRADE: very low).ConclusionsHealthcare professionals should ensure that people with dementia are encouraged to exercise and that primary carers are trained and supported to provide safe and effective care for the person with dementia. Acetylcholinesterase inhibitors or memantine should be trialled unless contraindicated.Trial registration numberCRD42015020179.

What does the general public understand about prevention and treatment of dementia? A systematic review of population-based surveys

“…It was noted, however, that the perceived value in treatment lay mostly in its potential to support wellbeing rather than slow the progression of symptoms. This is contrary to evidence that both pharmacological and non-pharmacological methods can delay functional and cognitive decline [ 3 , 62 ]. The general public was positive overall about the value of practicing healthy behaviours after a diagnosis of dementia.…”

What does the general public understand about prevention and treatment of dementia? A systematic review of population-based surveys

“…It was noted, however, that the perceived value in treatment lay mostly in its potential to support wellbeing rather than slow the progression of symptoms. This is contrary to evidence that both pharmacological and non-pharmacological methods can delay functional and cognitive decline [ 3 , 62 ]. The general public was positive overall about the value of practicing healthy behaviours after a diagnosis of dementia.…”

Behavioral Activation for Promoting Well-Being in Mild Dementia: Feasibility and Outcomes of a Pilot Randomized Controlled Trial

“…Our findings were overall in the expected direction, and are in line with evidence that BA may be associated with medium to large effects, being observed in relatively few sessions [35]. The reported changes compare favorably with effects of pharmacological treatments on function and activities of daily living for people with dementia which tend to be small [36].…”

An overview of systematic reviews of pharmacological and non-pharmacological interventions for the treatment of behavioral and psychological symptoms of dementia

“…Systematic reviews that were published in languages other than English or before the year 2000 were excluded. The methods used in this overview were consistent with methods from a previous published overview (Laver et al , 2016).…”

What does the general public understand about prevention and treatment of dementia? A systematic review of population-based surveys

“…It was noted, however, that the perceived value in treatment lay mostly in its potential to support wellbeing rather than slow the progression of symptoms. This is contrary to evidence that both pharmacological and non-pharmacological methods can delay functional and cognitive decline [ 3 , 62 ]. The general public was positive overall about the value of practicing healthy behaviours after a diagnosis of dementia.…”

Behavioral Activation for Promoting Well-Being in Mild Dementia: Feasibility and Outcomes of a Pilot Randomized Controlled Trial

“…Our findings were overall in the expected direction, and are in line with evidence that BA may be associated with medium to large effects, being observed in relatively few sessions [35]. The reported changes compare favorably with effects of pharmacological treatments on function and activities of daily living for people with dementia which tend to be small [36].…”

An overview of systematic reviews of pharmacological and non-pharmacological interventions for the treatment of behavioral and psychological symptoms of dementia

“…Systematic reviews that were published in languages other than English or before the year 2000 were excluded. The methods used in this overview were consistent with methods from a previous published overview (Laver et al , 2016).…”

What does the general public understand about prevention and treatment of dementia? A systematic review of population-based surveys

“…It was noted, however, that the perceived value in treatment lay mostly in its potential to support wellbeing rather than slow the progression of symptoms. This is contrary to evidence that both pharmacological and non-pharmacological methods can delay functional and cognitive decline [ 3 , 62 ]. The general public was positive overall about the value of practicing healthy behaviours after a diagnosis of dementia.…”

Behavioral Activation for Promoting Well-Being in Mild Dementia: Feasibility and Outcomes of a Pilot Randomized Controlled Trial

“…Our findings were overall in the expected direction, and are in line with evidence that BA may be associated with medium to large effects, being observed in relatively few sessions [35]. The reported changes compare favorably with effects of pharmacological treatments on function and activities of daily living for people with dementia which tend to be small [36].…”

An overview of systematic reviews of pharmacological and non-pharmacological interventions for the treatment of behavioral and psychological symptoms of dementia

“…Systematic reviews that were published in languages other than English or before the year 2000 were excluded. The methods used in this overview were consistent with methods from a previous published overview (Laver et al , 2016).…”