Non-Drug Treatments for Symptoms in Dementia: An Overview of Systematic Reviews of Non-Pharmacological Interventions in the Management of Neuropsychiatric Symptoms and Challenging Behaviours in Patients With Dementia
Erens, B., Dickson, K., et al. (2012).
London (United Kingdom): EPPI-Centre, 1-52.
This umbrella review of systematic reviews investigates the effectiveness of various non-pharmacological treatments used to remediate neuropsychiatric symptoms and challenging behaviors in adults with dementia. Only interventions within the scope of speech language pathology (SLP) are included within this article summary. Specific details about the included articles are available elsewhere in the Evidence Maps. See the Associated Article(s) section below for additional details.
Policy Research Programme of the Department of Health for England
This umbrella systematic review contains a number of reviews, only some of which are related to SLP practice. Of particular relevance to the article’s conclusions are the following reviews:<br />
<ul>
<li>Bates, J., Boote, J., & Beverley, C. (2004). Psychosocial interventions for people with a milder dementing illness: a systematic review. <em>Journal of Advanced Nursing, 45(6)</em>, 644–658. https://doi.org/10.1046/j.1365-2648.2003.02959.x</li>
<li>Boote, J., Lewin, V., Beverley, C., & Bates, J. (2006). Psychosocial interventions for people with moderate to severe dementia: a systematic review. <em>Clinical Effectiveness in Nursing, 9(Supplement 1):</em> e1-e15. https://doi.org/10.1016/j.cein.2006.06.002</li>
<li>Hulme, C., Wright, J., Crocker, T., Oluboyede, Y., & House, A. (2010). Non-pharmacological approaches for dementia that informal carers might try or access: a systematic review. <em>International Journal of Geriatric Psychiatry, 25(7)</em>, 756–763. https://doi.org/10.1002/gps.2429</li>
<li>Opie, J., Rosewarne, R., & O'Connor, D. W. (1999). The efficacy of psychosocial approaches to behaviour disorders in dementia: a systematic literature review. <em>The Australian and New Zealand Journal of Psychiatry, 33(6), 789–799.</em> https://doi.org/10.1046/j.1440-1614.1999.00652.x</li>
</ul>
From database inception to March 2011
Systematic reviews
30 (4 within SLP scope of practice)
<div>Overall, findings demonstrated that validation and reminiscence therapies were not associated with a significant change in the behavior of adults with dementia. Additionally, no significant effect of validation therapy was noted on the use of antipsychotics for these patients. Overall, there was evidence that validation therapy was unlikely to be effective, while the effectiveness of reminiscence therapy was unclear.</div>
<div>Only one systematic review regarding reality orientation therapy was located, with the overall effectiveness of this therapy being unclear. The majority of studies included within this review reported non-significant improvements in behavior or depression. Due to an overall paucity of research and differences in study designs, further research is indicated.</div>
<div>Mixed findings were noted regarding the impact of cognitive stimulation therapy on behavior for adults with dementia, with its overall effectiveness being unclear. Two out of three systematic reviews reported no significant effect, while one review reported that cognitive stimulation delivered within a group format was associated with positive behavioral outcomes. Further research is indicated due to a limited number of studies included within each review and differences in study designs.</div>
<div>Limited, low quality evidence demonstrated that environmental modifications (e.g., exit barriers, modifying lights and visual stimuli, removing dangerous equipment) were not generally associated with behavioral change in adults with dementia. Its overall effectiveness is unclear. Due to the reduced methodological rigor of included studies and an overall paucity of research, additional research is indicated.</div>
<div>Mixed results were reported regarding the use of behavioral cognitive techniques (e.g. distracting techniques, routine-based structure). Six randomized controlled trials reported that behavior management techniques were associated with a statistically significant reduction in challenging behaviors. Six additional studies, mostly of reduced quality, reported nonsignificant impacts on agitation, disruptive vocalizations, aggressive behaviors, and wandering. While these therapies are likely to be effective, additional, high quality research is indicated.</div>
<div>Inconsistent improvements in behaviors were noted for adults with dementia following the use of staff and caregiver training and support. No significant effect was noted on use of antipsychotics. While these therapies are likely to be effective, additional research is indicated in order to determine the overall effectiveness of various components within these training programs.</div>
<div>Within two systematic reviews, there was some evidence that admission into specialized care units versus traditional nursing homes was associated with improved behavioral outcomes for adults with dementia. The overall effectiveness of specialized care units versus general units was unclear. Designed environments combined with staff training had non-significant effects on behavior. Due to limited research of variable quality, additional research is indicated.</div>
