Introduction: Nonpharmacological therapies (NPTs) can improve the quality of life (QoL) of people with Alzheimer’s disease (AD) and their carers. The objective of this study was to evaluate the best evidence on the effects of NPTs in AD and related disorders (ADRD) by performing a systematic review and meta-analysis of the entire field. Methods: Existing reviews and major electronic databases were searched for randomized controlled trials (RCTs). The deadline for study inclusion was September 15, 2008. Intervention categories and outcome domains were predefined by consensus. Two researchers working together detected 1,313 candidate studies of which 179 RCTs belonging to 26 intervention categories were selected. Cognitive deterioration had to be documented in all participants, and degenerative etiology

/pdf/nonpharmacological-therapies-in-alzheimer-s-disease-a-4v6qod5q3r.pdf

Nonpharmacological therapies in Alzheimer's disease: a systematic review of efficacy

A meta-analysis showed that 9–12 sessions of supportive help delivered in the home to family caregivers for dementia patients had a salutary effect for the patients' behavioral symptoms, such as screaming and aggression, similar in size to the effect of pharmacological interventions. Psychosis was much less responsive. There was a smaller, but significant amelioration of caregiver reactions to the patient's behavioral symptoms.

https://ajp.psychiatryonline.org/doi/pdf/10.1176/appi.ajp.2012.11101529

Meta-Analysis of Nonpharmacological Interventions for Neuropsychiatric Symptoms of Dementia

Objective To provide an overview of non-pharmacological interventions for behavioural and psychological symptoms in dementia (BPSD). Design Systematic overview of reviews. Data sources PubMed, EMBASE, Cochrane Database of Systematic Reviews, CINAHL and PsycINFO (2009–March 2015). Eligibility criteria Systematic reviews (SRs) that included at least one comparative study evaluating any non-pharmacological intervention, to treat BPSD. Data extraction Eligible studies were selected and data extracted independently by 2 reviewers. The AMSTAR checklist was used to assess the quality of the SRs. Data analysis Extracted data were synthesised using a narrative approach. Results 38 SRs and 142 primary studies were identified, comprising the following categories of non-pharmacological interventions: (1) sensory stimulation interventions (12 SRs, 27 primary studies) that encompassed: acupressure, aromatherapy, massage/touch therapy, light therapy and sensory garden; (2) cognitive/emotion-oriented interventions (33 SRs; 70 primary studies) that included cognitive stimulation, music/dance therapy, dance therapy, snoezelen, transcutaneous electrical nerve stimulation, reminiscence therapy, validation therapy, simulated presence therapy; (3) behaviour management techniques (6 SRs; 32 primary studies) and (4) other therapies (5 SRs, 12 primary studies) comprising exercise therapy, animal-assisted therapy, special care unit and dining room environment-based interventions. Music therapy was effective in reducing agitation (SMD, −0.49; 95% CI −0.82 to −0.17; p=0.003), and anxiety (SMD, −0.64; 95% CI −1.05 to −0.24; p=0.002). Home-based behavioural management techniques, caregiver-based interventions or staff training in communication skills, person-centred care or dementia care mapping with supervision during implementation were found to be effective for symptomatic and severe agitation. Conclusions A large number of non-pharmacological interventions for BPSD were identified. The majority of the studies had great variation in how the same type of intervention was defined and applied, the follow-up duration, the type of outcome measured, usually with modest sample size. Overall, music therapy and behavioural management techniques were effective for reducing BPSD.

https://bmjopen.bmj.com/content/bmjopen/7/3/e012759.full.pdf

Systematic review of systematic reviews of non-pharmacological interventions to treat behavioural disturbances in older patients with dementia. The SENATOR-OnTop series.

It is increasingly recognised that pharmacological treatments for dementia should be used as a second-line approach and that non-pharmacological options should, in best practice, be pursued first. This review examines current non-pharmacological approaches. It highlights the more traditional treatments such as behavioural therapy, reality orientation and validation therapy, and also examines the potential of interesting new alternative options such as cognitive therapy, aromatherapy and multisensory therapies. The current literature is explored with particular reference to recent research, especially randomised controlled trials in the area. Although many non-pharmacological treatments have reported benefits in multiple research studies, there is a need for further reliable and valid data before the efficacy of these approaches is more widely recognised.

/pdf/non-pharmacological-interventions-in-dementia-4q192fk6p5.pdf

Non-pharmacological interventions in dementia

Background 

Tailored psychosocial interventions can help families to manage behavioural and psychological symptoms in dementia (BPSD), but carer responses to their relative's behaviours contribute to the success of support programmes.

Aims 

To understand why some family carers have difficulty in dealing with BPSD, in order to improve the quality of personalised care that is offered.

Method 

A systematic review and meta-ethnographic synthesis was conducted of high-quality quantitative and qualitative studies between 1980 and 2012.

Results 

We identified 25 high-quality studies and two main reasons for behaviours being reported as challenging by family carers: changes in communication and relationships, resulting in ‘feeling bereft’; and perceptions of transgressions against social norms associated with ‘misunderstandings about behaviour’ in the relative with dementia. The underlying belief that their relative had lost, or would inevitably lose, their identity to dementia was a fundamental reason why family carers experienced behaviour as challenging.

Conclusions 

Family carers' perceptions of BPSD as challenging are associated with a sense of a declining relationship, transgressions against social norms and underlying beliefs that people with dementia inevitably lose their ‘personhood’. Interventions for the management of challenging behaviour in family settings should acknowledge unmet psychological need in family carers.

/pdf/behavioural-and-psychological-symptoms-in-dementia-and-the-3wrhgq7pbz.pdf

Behavioural and psychological symptoms in dementia and the challenges for family carers: systematic review.

Background
Community mental health nurses (CMHNs) are the backbone of specialist mental health services in the UK. This study evaluated the effects of training CMHNs in a systematic psychosocial intervention (PSI), to help family carers manage behavioural changes in their relative with dementia.

Method
One hundred and thirteen family carers received PSI support from a ‘trained’ (experimental), or a ‘usual practice’ (control) CMHN. Primary (day-to-day behaviour problems and management) and secondary (carer mood) outcome measures were obtained at baseline, 6, 12 and 18 months. CMHN training and supervision commenced prior to, and continued throughout, the 18-month study.

Results
Patient cognition declined in both groups, but problem behaviour reduced in experimental group families. However this effect was associated with the practice of some, not all, CMHNs. Carer management and mood improved with PSI support. In contrast, by 18 months, families supported by conventional CMHNs reported reduced coping resources, increased problem behaviour and their level of depression worsened. Only two CMHNs adhered to the PSI-protocol.

Conclusions
Some, but not all, ‘trained’ CMHNs used the PSI to help family carers reduce behavioural problems. A relatively long but not intensive PSI of 12–18 months was needed to moderate carer mood. Dementia-specific practice arrangements, training and sustained clinical supervision are important for the delivery of effective psychosocial interventions in dementia. Copyright © 2007 John Wiley & Sons, Ltd.

Can training community mental health nurses to support family carers reduce behavioural problems in dementia? An exploratory pragmatic randomised controlled trial.

Objective

To examine the criterion validity of the Hospital Anxiety and Depression Scale (HADS) and the Geriatric Depression Scale 15-item (GDS-15) in a community sample of Chronic Heart Failure (CHF) out-patients.



Methods

Eighty-eight of 203 older adults with confirmed CHF responded to a postal survey and participated in a face-to-face interview. The GDS-15 and HADS were compared to diagnoses from the Structured Clinical Interview for DSM-IV (SCID-I), using a receiver operating characteristic (ROC) analysis and positive and negative predictive values, sensitivity and specificity for various cut-off points.



Results

For all depressive disorders, the area under the ROC curve for the GDS-15 was 0.883 and a cut-off of 5 gave a sensitivity of 0.818 and a specificity of 0.833. The area under the ROC curve for the HADS Depression (D) and Anxiety (A) were 0.889 and 0.941 respectively. At a cut-off of 7, the HADS-A gave a sensitivity of 0.938 and a specificity of 0.847. At a cut-off of 4, the HADS-D gave a sensitivity of 0.864 and a specificity of 0.788.



Conclusions

The GDS-15 and HADS are valid screening tools for detecting depression in aged CHF out-patients. However, use of the HADS requires reduced cut-points to ensure that patients with mood disorder are not missed in this population. Copyright © 2007 John Wiley & Sons, Ltd.

An evaluation of two self-report screening measures for mood in an out-patient chronic heart failure population.

The effect of a brief in-service training programme on the psychosocial management of behavioural disturbance in residential care is described. Although the incidence of problematic behaviour did not change 3 months after training, staff in the experimental homes reported a significant improvement in their management of problematic behaviour, as compared to the control home. However, these effects were not maintained a year later. The importance of post-training supervision and the sociocultural context of the home in the maintenance of psychosocial intervention in residential settings is discussed.

Can staff training reduce behavioural problems in residential care for the elderly mentally ill

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Can training community mental health nurses to support family carers reduce behavioural problems in dementia? An exploratory pragmatic randomised controlled trial.

An evaluation of two self-report screening measures for mood in an out-patient chronic heart failure population.

Can staff training reduce behavioural problems in residential care for the elderly mentally ill