Systematic review of evidence underpinning non-pharmacological therapies in dementia

Abstract

Dementia is one of the most common illnesses worldwide, and is one of the most important causes of disability in older people. Currently, dementia affects over 35million people around the globe. It is expected that this number will increase to 65.7million by 2030. Early detection, diagnosis and treatment to control the principal behaviour symptoms may help reduce these numbers and delay the progression to more advanced and dangerous stages of this disorder with resultant increase quality of life for those affected. The main goal of the present systematic literature review was to examine contemporary evidence relating to non-pharmacological therapy in the treatment of dementia. To achieve the study goal, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used. This study identified the five most common behaviours in patients with dementia as aggression, wandering, agitation, apathy and sleep disturbances. Two non-pharmacological therapies were the most studied treatment: music therapy and aromatherapy. Ten other non-pharmacological therapies were also identified, but these lack a sufficient evidence-base. Although all the therapies identified could be used as part of the treatment of behavioural symptoms, there is insufficient evidence relating to the indications, appropriate use and effectiveness of these therapies to apply in each behavioural treatment. Thus, the present study has demonstrated a significant research gap. Despite the widespread use of many different types of therapies, there is limited evidence regarding the efficacy of non-pharmaceutical therapies deployed in the management of behaviours of concern manifested by some people who suffer with dementia in all its forms. This systematic review examines contemporary evidence from the literature to determine whether there is an evidence base available that would underpin the use of these therapies. This report on a PRISMA systematic review of the available literature demonstrates that only two therapies have some evidence to underpin the use of these non-pharmaceutical therapies and that a significant research gap is exists. The implications for practitioners is that significant research effort is required to determine the efficacy of many of the therapies that are currently deployed, and thus many of the therapies used lack an evidence base at this time.

Recommendations for the Nonpharmacological Treatment of Apathy in Brain Disorders

“…In people with Mild and Major NCD, for example, NPTs have been shown to be effective in improving apathy administered alone 11 or combined with drug therapy 14,15 . A summary of the NPTs employed to reduce apathy (as a direct or indirect target), and the clinical populations on which they have been employed is presented in Table 1 (see 11,14,16 for more exhaustive reviews).…”

Impact of Pharmacotherapy on Insomnia in Patients with Alzheimer’s Disease

“…Anecdotal evidence has suggested that certain scents (e.g., lavender, lemon balm, cedar) may have mildly sedating properties when used in agitated people with dementia [172]. Few of these studies have examined sleep or specifically targeted nocturnal agitation as an outcome.…”

Nature-Based Video with Music for Individuals Experiencing an Episode of Sundown Syndrome

“…Music is one of the most studied activity interventions used to improve mood, such as agitation, and disruptive behavior for individuals with dementia (Olley & Morales, 2017). Overall, music interventions for individuals with dementia have involved either defined 'music therapy' programs (e.g., singing, music improvisation, playing instruments, and creating music) conducted by a credentialed music therapist or consisted of passive 'music listening' (e.g., pre-recorded or live music) not requiring a music therapist (Vink & Hanser, 2018).…”