Background Experiencing anxiety and depression is very common in people living with dementia and mild cognitive impairment (MCI). There is uncertainty about the best treatment approach. Drug treatments may be ineffective and associated with adverse effects. Guidelines recommend psychological treatments. In this updated systematic review, we investigated the effectiveness of different psychological treatment approaches. Objectives Primary objective To assess the clinical effectiveness of psychological interventions in reducing depression and anxiety in people with dementia or MCI. Secondary objectives To determine whether psychological interventions improve individuals' quality of life, cognition, activities of daily living (ADL), and reduce behavioural and psychological symptoms of dementia, and whether they improve caregiver quality of life or reduce caregiver burden. Search methods We searched ALOIS, the Cochrane Dementia and Cognitive Improvement Group's register, MEDLINE, Embase, four other databases, and three trials registers on 18 February 2021. Selection criteria We included randomised controlled trials (RCTs) that compared a psychological intervention for depression or anxiety with treatment as usual (TAU) or another control intervention in people with dementia or MCI. Data collection and analysis A minimum of two authors worked independently to select trials, extract data, and assess studies for risk of bias. We classified the included psychological interventions as cognitive behavioural therapies (cognitive behavioural therapy (CBT), behavioural activation (BA), problem‐solving therapy (PST)); 'third‐wave' therapies (such as mindfulness‐based cognitive therapy (MBCT)); supportive and counselling therapies; and interpersonal therapies. We compared each class of intervention with control. We expressed treatment effects as standardised mean differences or risk ratios. Where possible, we pooled data using a fixed‐effects model. We used GRADE methods to assess the certainty of the evidence behind each result. Main results We included 29 studies with 2599 participants. They were all published between 1997 and 2020. There were 15 trials of cognitive behavioural therapies (4 CBT, 8 BA, 3 PST), 11 trials of supportive and counselling therapies, three trials of MBCT, and one of interpersonal therapy. The comparison groups received either usual care, attention‐control education, or enhanced usual care incorporating an active control condition that was not a specific psychological treatment. There were 24 trials of people with a diagnosis of dementia, and five trials of people with MCI. Most studies were conducted in community settings. We considered none of the studies to be at low risk of bias in all domains. Cognitive behavioural therapies (CBT, BA, PST) Cognitive behavioural therapies are probably slightly better than treatment as usual or active control conditions for reducing depressive symptoms (standardised mean difference (SMD) ‐0.23, 95% CI ‐0.37 to ‐0.10; 13 trials, 893 participants; moderate‐certainty evidence). They may also increase rates of depression remission at the end of treatment (risk ratio (RR) 1.84, 95% CI 1.18 to 2.88; 2 studies, with one study contributing 2 independent comparisons, 146 participants; low‐certainty evidence). We were very uncertain about the effect of cognitive behavioural therapies on anxiety at the end of treatment (SMD ‐0.03, 95% CI ‐0.36 to 0.30; 3 trials, 143 participants; very low‐certainty evidence). Cognitive behavioural therapies probably improve patient quality of life (SMD 0.31, 95% CI 0.13 to 0.50; 7 trials, 459 participants; moderate‐certainty evidence) and activities of daily living at end of treatment compared to treatment as usual or active control (SMD ‐0.25, 95% CI ‐0.40 to ‐0.09; 7 trials, 680 participants; moderate‐certainty evidence). Supportive and counselling interventions Meta‐analysis showed that supportive and counselling interventions may have little or no effect on depressive symptoms in people with dementia compared to usual care at end of treatment (SMD ‐0.05, 95% CI ‐0.18 to 0.07; 9 trials, 994 participants; low‐certainty evidence). We were very uncertain about the effects of these treatments on anxiety, which was assessed only in one small pilot study. Other interventions There were very few data and very low‐certainty evidence on MBCT and interpersonal therapy, so we were unable to draw any conclusions about the effectiveness of these interventions. Authors' conclusions CBT‐based treatments added to usual care probably slightly reduce symptoms of depression for people with dementia and MCI and may increase rates of remission of depression. There may be important effect modifiers (degree of baseline depression, cognitive diagnosis, or content of the intervention). CBT‐based treatments probably also have a small positive effect on quality of life and activities of daily living. Supportive and counselling interventions may not improve symptoms of depression in people with dementia. Effects of both types of treatment on anxiety symptoms are very uncertain. We are also uncertain about the effects of other types of psychological treatments, and about persistence of effects over time. To inform clinical guidelines, future studies should assess detailed components of these interventions and their implementation in different patient populations and in different settings. 

/pdf/psychological-treatments-for-depression-and-anxiety-in-hqcazsnm.pdf

Psychological treatments for depression and anxiety in dementia and mild cognitive impairment

Aim To explore the best non-pharmaceutical interventions for improving the behavioural and psychological symptoms in elders with dementia. Design Bayesian network meta-analysis. Methods A comprehensive electronic literature search was performed in five English databases and four Chinese databases to identify relevant randomized controlled trials (RCTs) that were published up to 31 October 2019. Results A total of 41 RCTs were included in this network meta-analysis involving 5 different non-pharmacological interventions: therapeutic recreation (TC), reminiscence therapy (RT), behaviour therapy (BT), massage therapy (MT) and individualized nursing (IN).The results of network meta-analysis showed that individualized nursing was the best in improving depression, cognitive function, and activities of daily living of behavioural and psychological symptoms of dementia. Behaviour therapy was the best in improving anxiety symptoms. Reminiscence therapy was the best in improving neuropsychiatric symptoms.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/nop2.1049

Comparative efficacy of non-pharmacological interventions on behavioural and psychological symptoms in elders with dementia: A network meta-analysis.

This study aimed to investigate the effectiveness of phototherapy intervention on cognitive function in older adult patients with dementia. PubMed, Ovid MEDLINE, Web of Science, EMBASE, Cochrane Central Registry of Controlled Trials, PsycINFO, and Clinical Trials were searched from their inception to August 10, 2022, for randomized controlled trials involving patients with dementia who received phototherapy interventions. We used the weighted mean difference (MD) or standard weighted mean difference to generate the pooled estimates. The primary outcome was cognitive function as measured by the Mini‐Mental State Examination (MMSE) score. The secondary outcomes were the behavioral and psychological symptoms of dementia (BPSDs) and sleep. This systematic review and meta‐analysis was registered in PROSPERO (registration number: CRD42022343788). We included 12 randomized controlled trials comprising 766 patients with dementia (426 patients in the intervention group and 340 in the control group). Phototherapy interventions significantly improved MMSE scores (n = 3, MD 2.68, 95% confidence interval [CI]: 1.38–3.98, I2 = 0%). There were no significant differences in the Cornell Scale for Depression in Dementia score, Cohen‐Mansfield Agitation Inventory score (MD: −3.12, 95% CI: −8.05, 1.82, I2 = 0%), Neuropsychiatric Inventory score, sleep efficiency, total sleep time, and Sleep Disorders Inventory score between the groups. Our systematic review and meta‐analysis showed that phototherapy significantly improved cognitive function in patients with dementia.

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/brb3.2952

Phototherapy improves cognitive function in dementia: A systematic review and meta‐analysis

In the paper by Obradovic et al., the first name and surname of the authors have been interchanged. The correct names of the author are listed below: Slobodan Obradovic, Boris Dzudovic, Bojana Subotic, Jovan Matijasevic, Zorica Mladenovic, Aleksandar Bokan, Jadranka Trobok, Sandra Pekovic, Sonja Salinger-Martinovic, Ljiljana Jovanovic, Ljiljana Kos, Tamara Kovacevic-Preradovic, Maja Nikolic, Vladimir Miloradovic, Ana Kovacevic-Kuzmanovic, Zec Nenad, Natasa Markovic-Nikolic, Ilija Srdanovic, Zoran Gluvic, Srdjan Kafedzic, Sasa Pancevacki, Aleksandar Neskovic and Stavros Konstantinides.

Corrigendum

Nurses' competencies are crucial in providing effective dementia care in healthcare settings for older people. Understanding nurses' current knowledge, attitudes and confidence in this area is essential for developing education programmes for healthcare professionals to improve patient care. The purpose of this study was to assess the knowledge, attitudes and confidence related to providing dementia care among nurses practicing in geriatric hospital wards and nursing homes in Hanoi, Vietnam. 

Knowledge, Attitudes and Confidence in Providing Dementia Care to Older Adults Among Nurses Practicing in Hanoi, Vietnam: A Cross‐Sectional Study

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Comparative efficacy of non-pharmacological interventions on behavioural and psychological symptoms in elders with dementia: A network meta-analysis.