A Systematic Review of Quality Dementia Clinical Guidelines for the Development of WHO’s Package of Interventions for Rehabilitation

Gerontologist

Jeon, Y. H., Krein, L., et al. (2023).

Gerontologist, 63(9), 1536-1555.

This umbrella review of guidelines investigates interventions for people with dementia. Specific details regarding included articles are available elsewhere in the Evidence Maps. See the Associated Article(s) section below for the citations.

None declared

This umbrella review contains a number of guidelines, only some of which are related to SLP or Audiology practice. Of particular relevance to the article&rsquo;s conclusions are the following reviews: <br /> <ul> <li><span style="color: #333333;">Bachoud-L&eacute;vi, A.C., Ferreira, J., et al. (2019). International Guidelines for the Treatment of Huntington&rsquo;s Disease. <em>Frontiers in Neurology, 10</em>, 710. https://doi.org/10.3389/fneur.2019.00710</span></li> <li><span style="color: #333333;">Guideline Adaptation Committee (2016). Clinical Practice Guidelines and Principles of Care for People With Dementia. Sydney (Australia): NHMRC Partnership Centre for Dealing with Cognitive and Related Functional Decline in Older People, 2-27. </span></li> <li><span style="color: #333333;">National Institute for Health and Care Excellence. (2018). Dementia: Assessment, Management, and Support for People Living With Dementia and Their Carers. London (United Kingdom): National Institute for Health and Care Excellence, 1-419.</span></li> </ul>

January 2010 to March 2020

Clinical and/or practice guidelines

6

<div>Based upon the systematic review of six clinical practice guidelines, the following recommendations regarding cognitive interventions for people with dementia were compiled:</div> <ul> <li>Do not offer cognitive training to treat mild to moderate Alzheimer's disease (Strong Recommendation; Very Low to Moderate Quality of Evidence),</li> <li>Do not offer interpersonal therapy to treat cognitive symptoms of mild to moderate Alzheimer's disease (Strong Recommendation; Level of evidence not available),</li> <li>Cognitive stimulation to improve executive functioning may be used (Expert Opinion; Level of evidence not available),</li> <li>Multiple rehabilitation strategies may be used to improve/stabilize transitorily cognitive functions (Strength of recommendation not provided; Moderate Quality of Evidence),</li> <li>Offer group cognitive stimulation therapy to people with mild to moderate dementia (Strong Recommendation; Moderate Quality of Evidence),</li> <li>Use cognitive stimulation to improve social participation (Strong Recommendation; High Quality of Evidence),</li> <li>Consider group reminiscence therapy for people with mild to moderate dementia (Strong Recommendation; Moderate Quality of Evidence),</li> <li>Selectively use multisensory intervention and ambient music outside of mealtimes (Strong Recommendation; High Quality of Evidence),</li> <li>Incorporate personalized activities to promote engagement, pleasure, and interest (Strong Recommendation; Level of evidence not available), and</li> <li>Use errorless learning and prompting routinely (Strong Recommendation; High Quality of Evidence).</li> </ul>

<div>Based upon the systematic review of six clinical practice guidelines, the following expert opinion recommendations regarding compensatory strategies for people with dementia were compiled:</div> <ul> <li>Verbal and visual cues may be considered to help recalling items,</li> <li>Compensatory strategies (establishing and keeping a regular daily routine, organizing a schedule, keeping a diary, and drawing up a "to do" list) may be offered,</li> <li>Communication strategies and techniques including management options and advice on facilitation of communication should be provided,</li> <li>Personalized cognitive stimulation is recommended including establishing routines and a structured program of activities for apathy, with education to family regarding the various aspects and causes of apathy, and</li> <li>Establishment of a regular routine and milestones is recommended to manage time better, with external stimuli (e.g., reminders, alarms) as needed (Expert Opinion; Level of evidence not available).</li> </ul>

<div>Based upon the systematic review of six clinical practice guidelines, the following recommendations were compiled regarding interventions for agitation in individuals with dementia:</div> <ul> <li><span style="color: #333333;">Consider behavioral strategies to address irritability (Expert Opinion; Level of evidence not available),</span></li> <li><span style="color: #333333;">Offer psychosocial and environmental interventions to reduce distress as a first option (Strong Recommendation; Moderate Quality of Evidence),</span></li> <li><span style="color: #333333;">Ensure continued access to psychosocial and environmental interventions for distress while on and after antipsychotics (Strong Recommendation; Low to Very Low Quality of Evidence), and</span></li> <li><span style="color: #333333;">Offer multicomponent interventions involving tailored activities for depression and/or anxiety or agitation (Weak or Conditional Recommendation; Low to Very Low Quality of Evidence).</span></li> </ul>

<div>Screen adults with dementia for delirium risk factors. Monitor for changes in delirium symptoms, with education provided to people who are at risk of delirium (Strength of recommendation not provided; Very Low to High Quality of Evidence).</div>

<div>Based upon the systematic review of six clinical practice guidelines, the following recommendations were compiled regarding the assessment of people with dementia:</div> <ul> <li>Comprehensive assessment of language and other factors (mood, motivation, and behavior) should be conducted (Expert Opinion; Level of evidence not available),</li> <li>Assessment of language should include orofacial movements, respiratory function in speech, breath control and coordination, phonation, articulation, intelligibility, comprehension and communication abilities (Strength of recommendation not provided; Low Quality of Evidence),</li> <li>The objective measurement of behavioral and psychological symptoms of dementia should be undertaken using tools with strong psychometric properties and used to monitor the type and patterns of behaviors (Strength of recommendation not provided; Very Low Quality of Evidence),</li> <li>Environmental, physical health, and psychosocial factors should be assessed and addressed to prevent behaviors and psychological symptoms (Strength of recommendation not provided; Very Low Quality of Evidence), and</li> <li>Assess and monitor for depression and changes in symptoms/response to treatment (Strength of recommendation not provided; Very Low Quality of Evidence).</li> </ul>

<div>Use signage, environmental design principles, personal memorabilia, and other environmental cues (Weak or Conditional Recommendation; Level of evidence not available).</div>

<div>A multidisciplinary approach to dysphagia may include speech and occupational therapists (Expert Opinion; Level of evidence not available).</div>

<div>Artificial feeding in people with severe dementia should be avoided, with consideration for ethical and legal principles when making decisions about introducing or withdrawing artificial nutritional support (Weak or Conditional Recommendation; Very Low Quality of Evidence).</div>

<div>Consider weight loss, swallowing ability, cognitive changes, behavior, mood, and general functional ability together to prevent malnutrition (Strength of evidence not provided; Low Quality of Evidence).</div>

<div>Multiple rehabilitation strategies and disciplines (e.g., speech therapy, occupational therapy, cognitive, psychomotor) are recommended to improve speech, language, and communication (Strength of recommendation not provided; Moderate Quality of Evidence).</div>

<div>Based upon the systematic review of six clinical practice guidelines, the following recommendations were compiled regarding patient and caregiver counseling and education:</div> <ul> <li>Offer carepartner counseling (Strength of recommendation not provided; Low Quality of Evidence),</li> <li>Offer carepartner communication skills training, either alone or in combination with memory aid training (Strong recommendation; High Quality of Evidence),</li> <li>Regularly assess the carepartners' needs, with education provided regarding their right to a formal assessment, as well as ways to access formal assessments (Strong Recommendation; Very Low Quality of Evidence),</li> <li>Consider a reframing therapy approach for carepartners when anxiety, stress, and depressive symptoms are present (Strong Recommendation; High Quality of Evidence),</li> <li>Offer carepartner support groups (Strong Recommendation; High Quality of Evidence),</li> <li>Offer communication partner training, meaningful activity planning, environmental redesign and modification, and problem-solving and management planning (Strong Recommendation; Low Quality of Evidence), and</li> <li>Provide individually tailored written and verbal information planning (Strong Recommendation; Very Low Quality of Evidence) about: dementia in general (Strong Recommendation; Very Low Quality of Evidence), social support groups (Strong Recommendation; Very Low Quality of Evidence), appropriate services (Strong Recommendation; Very Low Quality of Evidence), depression (Strength of recommendation not provided; Very Low Quality of Evidence), good oral hygiene (Strength of recommendation not provided; Very Low Quality of Evidence), and accessing resources and support (Strong Recommendation; Very Low Quality of Evidence).&nbsp;</li> </ul>