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Reducing the Impact of Dementia in America: A Decadal Survey of the Behavioral and Social Sciences (2021)

Chapter: Appendix C: Synthesis of Reviews of Nonpharmacologic Interventions

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Suggested Citation:"Appendix C: Synthesis of Reviews of Nonpharmacologic Interventions." National Academies of Sciences, Engineering, and Medicine. 2021. Reducing the Impact of Dementia in America: A Decadal Survey of the Behavioral and Social Sciences. Washington, DC: The National Academies Press. doi: 10.17226/26175.
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Suggested Citation:"Appendix C: Synthesis of Reviews of Nonpharmacologic Interventions." National Academies of Sciences, Engineering, and Medicine. 2021. Reducing the Impact of Dementia in America: A Decadal Survey of the Behavioral and Social Sciences. Washington, DC: The National Academies Press. doi: 10.17226/26175.
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Author Method Dates of Studies Reviewed Population No. of Studies Included Included Study Designs
Cotelli et al., 2019 Systematic review 2005–2016 Persons living with mild cognitive impairment, Alzheimer’s disease, or frontotemporal dementia 5 Randomized controlled trial
Tay et al., 2019 Systematic review 1998–2017 Persons living with dementia 11
  • Quasi-experimental
  • Randomized controlled trial
Lim et al., 2019 Systematic review 2009–2017 Persons in the early stages of dementia or mild cognitive impairment 9
  • Nonrandomized controlled trial
  • Nonrandomized prospective study
  • Randomized controlled trial
Bahar-Fuchs et al., 2019 Systematic review and meta-analysis 1988–2018 Persons living with mild to moderate dementia 33 (32 included in meta-analysis) Randomized controlled trial
Suggested Citation:"Appendix C: Synthesis of Reviews of Nonpharmacologic Interventions." National Academies of Sciences, Engineering, and Medicine. 2021. Reducing the Impact of Dementia in America: A Decadal Survey of the Behavioral and Social Sciences. Washington, DC: The National Academies Press. doi: 10.17226/26175.
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Types of Interventions Outcomes Examined for Persons Living with Dementia Key Findings
Cognitive telerehabilitation Cognitive ability
  • Overall, studies were of low quality.
  • Telerehabilitation may be comparable to face-to-face cognitive rehabilitation.
Cognitive-behavioral therapy
  • Anxiety
  • Depression
  • Preliminary evidence indicates cognitive-behavioral therapy is effective at reducing anxiety and depressive symptoms among persons with dementia.
  • More rigorous trials are need.
Tai chi
  • Short-term cognitive function
  • Global cognitive functions
  • Working memory and executive function
  • Verbal learning and memory
  • Self-perception of memory
  • Attention and concentration
  • Semantic memory
  • Visuospatial skills
Tai chi has the potential to improve short-term cognitive function in the early stages of dementia.
Cognitive training
  • Global cognition
  • Clinical disease severity
  • Delayed memory ability
  • Capacity to perform activities of daily living
  • Mood and well-being of participant
  • Mood and well-being of informant/caregiver
  • Participant/treatment burden (retention rates)
  • Moderate-quality evidence indicates cognitive training relative to control, but not alternative treatment, is associated with small to moderate effects on global cognition and verbal semantic fluency.
  • Medium- to long-term follow-up evidence of cognitive training is low.
Suggested Citation:"Appendix C: Synthesis of Reviews of Nonpharmacologic Interventions." National Academies of Sciences, Engineering, and Medicine. 2021. Reducing the Impact of Dementia in America: A Decadal Survey of the Behavioral and Social Sciences. Washington, DC: The National Academies Press. doi: 10.17226/26175.
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Author Method Dates of Studies Reviewed Population No. of Studies Included Included Study Designs
Yen and Lin, 2018 Systematic review 2004–2010 Older adults living with and without dementia 16
  • Nonexperimental studies
  • Qualitative studies
  • Randomized controlled trial
van der Steen et al., 2018 Systematic review and meta-analysis 1993–2016 Persons living with dementia 22 (21 included in meta-analysis) Randomized controlled trial
van den Berg et al., 2018 Systematic review 1991–2017 Persons living with dementia 17
  • Case reports
  • Chart review
  • Prospective cohort
Spencer et al., 2018 Systematic review 2009 Persons living with dementia 1 Cluster randomized controlled study
Russell-Williams et al., 2018 Review 2010–2016 Persons living with dementia, mild cognitive impairment, or subjective cognitive decline 10
  • Randomized controlled trial
  • Quasi-experimental
Suggested Citation:"Appendix C: Synthesis of Reviews of Nonpharmacologic Interventions." National Academies of Sciences, Engineering, and Medicine. 2021. Reducing the Impact of Dementia in America: A Decadal Survey of the Behavioral and Social Sciences. Washington, DC: The National Academies Press. doi: 10.17226/26175.
×
Types of Interventions Outcomes Examined for Persons Living with Dementia Key Findings
Reminiscence therapy
  • Daily functioning
  • Cognition
  • Depression
  • Mood status
  • Self-esteem
  • Life satisfaction
  • Findings were not separated for populations with and without dementia.
  • Reminiscence therapy is associated with improved quality of life and depressive symptoms among older adults.
Music therapy
  • Emotional well-being (quality of life and positive affect)
  • Mood and affect
  • Behaviors
  • Cognition
  • Low-quality evidence indicates music-based interventions may improve emotional well-being and quality of life and reduce anxiety.
  • Moderate-quality evidence indicates music-based interventions reduce depressive symptoms and overall behaviors, but there is no effect on agitation/aggression.
  • Low-quality evidence indicates music-based interventions have no effect on cognition.
  • Conclusions could not be drawn regarding the effect of music-based interventions on social behavior or outcomes at long-term follow-up.
Electroconvulsive therapy Agitation and aggression Clinical improvements were observed in most of the studies, but the lack of randomized controlled trials limits inference.
De-escalation techniques for managing aggression
  • Aggression
  • Behaviors
A single study with high risk of bias found no difference in change in overall behavior.
Meditation:
  • Mindfulness
  • Kirtan kriya meditation
  • Mindfulness-based Alzheimer’s stimulation
  • Stress
  • Cognition
  • Quality of life
  • Medication may result in improvements in stress, cognition, and quality of life.
  • More rigorous studies are needed.
Suggested Citation:"Appendix C: Synthesis of Reviews of Nonpharmacologic Interventions." National Academies of Sciences, Engineering, and Medicine. 2021. Reducing the Impact of Dementia in America: A Decadal Survey of the Behavioral and Social Sciences. Washington, DC: The National Academies Press. doi: 10.17226/26175.
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Author Method Dates of Studies Reviewed Population No. of Studies Included Included Study Designs
Peluso et al., 2018 Review 1995–2016 Persons living with dementia and/or psychiatric disorders 16
  • Nonrandomized clinical trial
  • Randomized controlled trial
Oltra-Cucarella et al., 2018 Systematic review and meta-analysis 1993–2016 Persons living with Alzheimer’s disease or mixed dementias 33
  • Nonrandomized clinical trial
  • Randomized controlled trial
Mohler et al., 2018 Systematic review and meta-analysis 2000–2015 Persons living with dementia 8 (7 included in meta-analysis)
  • Controlled clinical trial
  • Randomized controlled trial
Lorusso and Bosch, 2018 Systematic review 2001–2014 Persons living with dementia 12
  • Quasi-experimental
  • Randomized controlled trial
Liang et al., 2018 Systematic review and network meta-analysis 2004–2016 Persons living with Alzheimer’s disease or mild cognitive impairment 17 Randomized controlled trial
Hu et al., 2018 Systematic review and meta-analysis 1999–2016 Persons living with cognitive impairment, including dementia and mild cognitive impairment 10
  • Quasi-experimental
  • Randomized controlled trial
Suggested Citation:"Appendix C: Synthesis of Reviews of Nonpharmacologic Interventions." National Academies of Sciences, Engineering, and Medicine. 2021. Reducing the Impact of Dementia in America: A Decadal Survey of the Behavioral and Social Sciences. Washington, DC: The National Academies Press. doi: 10.17226/26175.
×
Types of Interventions Outcomes Examined for Persons Living with Dementia Key Findings
Animal-assisted therapy
  • Cognition
  • Behavior
  • Depression
  • Physical function
  • Quality of life
  • Social function
Preliminary evidence from studies of low quality indicates that in persons with dementia, animal-assisted therapy may decrease problem behaviors and improve quality of life and social skills.
Cognition-focused interventions:
  • Cognitive rehabilitation
  • Cognitive training
  • Cognitive stimulation
  • Cognition
  • Attention
  • Memory
  • Naming
  • Executive functioning
  • Physical functioning
Cognition-focused interventions have limited effects on cognition or function compared with non–cognition focused interventions.
Tailored activities
  • Behavior
  • Quality of life
  • Affect
  • Mood
  • Cost
  • For persons with dementia living in long-term care facilities, low-quality evidence indicates tailored activities may marginally improve behaviors.
  • Evidence was inconclusive for quality of life, affect, and mood-related outcomes.
Multisensory environments
  • Behavior
  • Mood
  • Multisensory interventions may reduce behaviors and have a positive impact on mood.
  • Long-term effects are mixed, and rigorous studies are needed.
  • Physical exercise
  • Music therapy
  • Computerized cognitive training
  • Nutrition therapy
  • Cognitive functioning
  • Behavior
  • For persons with mild to moderate dementia, physical exercise may improve cognition.
  • For persons with mild to moderate dementia, computerized cognitive training may improve behavior.
Animal-assisted intervention
  • Behaviors
  • Daily living activities
  • Cognition
  • Quality of life
  • For persons with cognitive impairment, animal-assisted interventions may reduce problem behaviors.
  • For persons with cognitive impairment, animal-assisted interventions may have no effect on daily activities, cognition, or quality of life.
Suggested Citation:"Appendix C: Synthesis of Reviews of Nonpharmacologic Interventions." National Academies of Sciences, Engineering, and Medicine. 2021. Reducing the Impact of Dementia in America: A Decadal Survey of the Behavioral and Social Sciences. Washington, DC: The National Academies Press. doi: 10.17226/26175.
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Author Method Dates of Studies Reviewed Population No. of Studies Included Included Study Designs
Herke et al., 2018 Systematic review 1986–2015 Persons living with dementia 9 Randomized controlled trial
Fusar-Poli et al., 2018 Systematic review and meta-analysis 2009–2014 Persons living with dementia 6 Randomized controlled trial
Frederiksen et al., 2018 Systematic review 2006–2017 Persons living with no cognitive impairment (6 studies) Individuals with subjective memory complaints, mild cognitive impairment, or Alzheimer’s disease (2 studies) 8 Randomized controlled trial
Duan et al., 2018 Systematic review and network meta-analysis 2006–2016 Persons living with dementia 10 Randomized controlled trial
Suggested Citation:"Appendix C: Synthesis of Reviews of Nonpharmacologic Interventions." National Academies of Sciences, Engineering, and Medicine. 2021. Reducing the Impact of Dementia in America: A Decadal Survey of the Behavioral and Social Sciences. Washington, DC: The National Academies Press. doi: 10.17226/26175.
×
Types of Interventions Outcomes Examined for Persons Living with Dementia Key Findings
Environmental or behavior modifications for food and fluid intake
  • Food and fluid intake
  • Nutritional status
  • Secondary outcomes: mealtime behavior, global and specific cognitive function, daily function, quality of life
Conclusions could not be made due to heterogeneity in interventions and poor study design.
Music therapy
  • Cognition
  • Attention
  • Executive function
  • Learning and memory
  • Language
  • Motor skills
  • Overall music therapy had no effect on all outcomes.
  • A secondary analysis found that active music therapy had a positive effect on global cognition.
Physical exercise
  • Hippocampal volume
  • Biomarkers: cerebrospinal fluid, amyloid-B, tau
For persons with dementia, two small studies found physical exercise had no effect on biomarker outcomes.
  • Home-based exercise
  • Group exercise
  • Walking program
  • Reminiscence therapy
  • Art therapy
  • Psychosocial interventions + acetylcholinesterase inhibitor
  • Cognitive stimulation + acetylcholinesterase inhibitor
  • Cognition
  • Compliance
  • Psychosocial interventions including walking, home/group exercise, reminiscence therapy, and art therapy are more effective than usual care on measures of cognition.
  • Nonpharmacologic intervention + acetylcholinesterase inhibitor is more effective than acetylcholinesterase inhibitor alone on measures of cognition.
  • Compliance was greater for persons in walking and home-based exercise interventions compared with those in group exercise and art therapy interventions.
Suggested Citation:"Appendix C: Synthesis of Reviews of Nonpharmacologic Interventions." National Academies of Sciences, Engineering, and Medicine. 2021. Reducing the Impact of Dementia in America: A Decadal Survey of the Behavioral and Social Sciences. Washington, DC: The National Academies Press. doi: 10.17226/26175.
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Author Method Dates of Studies Reviewed Population No. of Studies Included Included Study Designs

Deshmukh et al., 2018 Systematic review 2006–2011 Persons living with dementia 2 Randomized controlled trial
Theleritis et al., 2018 Systematic review 1998–2016 Persons living with dementia 43
  • Quasi-experimental study
  • Randomized controlled trial
Wu et al., 2017 Systematic review and meta-analysis 2005–2015 Persons living with dementia 11
  • Quasi-experimental studies
  • Randomized controlled trial
Wood et al., 2017 Systematic mapping review 2001–2015 Persons living with dementia 10
  • Quasi-experimental studies
  • Randomized controlled trial
Suggested Citation:"Appendix C: Synthesis of Reviews of Nonpharmacologic Interventions." National Academies of Sciences, Engineering, and Medicine. 2021. Reducing the Impact of Dementia in America: A Decadal Survey of the Behavioral and Social Sciences. Washington, DC: The National Academies Press. doi: 10.17226/26175.
×
Types of Interventions Outcomes Examined for Persons Living with Dementia Key Findings
  • Mindfulness-based Alzheimer’s stimulation + acetylcholinesterase inhibitor
  • Progressive muscle relaxation + acetylcholinesterase inhibitor
  • Cognitive training + acetylcholinesterase inhibitor
Art therapy
  • Cognition
  • Depression
  • Quality of life
Evidence is insufficient to draw conclusions regarding the effect of art therapy on outcomes.
Nonpharmacologic:
  • Staff training
  • Multisensory
  • Walking
  • Emotion-oriented care
  • Individualized activity
  • Reminiscence therapy
  • Music
  • Art therapy
  • Cognitive therapy
Apathy
  • Most studies do not include apathy as a primary outcome measure.
  • Nonpharmacologic treatment for apathy is safe and may be effective, but overall, more rigorous studies are needed.
  • Massage
  • Touch therapy
Behaviors Low-quality evidence is insufficient to draw conclusions.
Animal-assisted therapies incorporating dogs Quality of life
  • For persons with dementia residing in long-term care facilities, animal-assisted therapy may improve quality of life.
  • More rigorous studies are needed.
Suggested Citation:"Appendix C: Synthesis of Reviews of Nonpharmacologic Interventions." National Academies of Sciences, Engineering, and Medicine. 2021. Reducing the Impact of Dementia in America: A Decadal Survey of the Behavioral and Social Sciences. Washington, DC: The National Academies Press. doi: 10.17226/26175.
×
Author Method Dates of Studies Reviewed Population No. of Studies Included Included Study Designs
Theleritis et al., 2017 Systematic review and meta-analysis 2004–2016 Persons living with Alzheimer’s disease 22
  • Quasi-experimental studies
  • Randomized controlled trial
Streater et al., 2017 Systematic and scoping review 1982–2013 Persons living with dementia 7
  • Quasi-experimental studies
  • Randomized controlled trial
Suggested Citation:"Appendix C: Synthesis of Reviews of Nonpharmacologic Interventions." National Academies of Sciences, Engineering, and Medicine. 2021. Reducing the Impact of Dementia in America: A Decadal Survey of the Behavioral and Social Sciences. Washington, DC: The National Academies Press. doi: 10.17226/26175.
×
Types of Interventions Outcomes Examined for Persons Living with Dementia Key Findings
Nonpharmacologic:
  • Cognitive training (group sessions)
  • Reminiscence therapy (group sessions)
  • Individualized cognitive rehabilitation program (individual sessions)
  • Biography-orientated mobilization
  • Music and art therapy
  • Nursing home staff education program
  • Multisensory
  • Cognitive stimulation, physical activity, and socialization
  • Activities
Apathy
  • Most studies do not include apathy as a primary outcome measure.
  • Heterogeneity of studies and poor study designs limit inferences, but several nonpharmacologic interventions are effective in reducing apathy.
Crisis management:
  • Psychiatry service
  • Outreach support
  • Crisis resolution home treatment team
  • Mental and behavioral health
  • Individualized care plan
  • Hospitalizations
  • Institutionalization
  • Quality of life
  • Cognition
  • Activities of daily living
  • Mortality
  • Use of medication
  • Patient/caregiver satisfaction
  • The overall effectiveness of crisis management on key outcomes is inconclusive.
  • More rigorous studies are needed.
Suggested Citation:"Appendix C: Synthesis of Reviews of Nonpharmacologic Interventions." National Academies of Sciences, Engineering, and Medicine. 2021. Reducing the Impact of Dementia in America: A Decadal Survey of the Behavioral and Social Sciences. Washington, DC: The National Academies Press. doi: 10.17226/26175.
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Author Method Dates of Studies Reviewed Population No. of Studies Included Included Study Designs
Smallfield and Heckenlaible, 2017 Systematic review 2006–2014 Persons living with Alzheimer’s disease and related neurocognitive disorders 52
  • Quasi-experimental studies
  • Randomized controlled trial
Lewis et al., 2017 Systematic review 2008–2015 Persons living with cognitive impairment 7 (6 included in meta-analysis) Randomized controlled trial
Karssemeijer et al., 2017 Systematic review and meta-analysis 2008–2017 Persons living with mild cognitive impairment or dementia 10 Randomized controlled trial
Karkou and Meekums, 2017 Systematic review N/A Persons living with dementia 0 Randomized controlled trial
Suggested Citation:"Appendix C: Synthesis of Reviews of Nonpharmacologic Interventions." National Academies of Sciences, Engineering, and Medicine. 2021. Reducing the Impact of Dementia in America: A Decadal Survey of the Behavioral and Social Sciences. Washington, DC: The National Academies Press. doi: 10.17226/26175.
×
Types of Interventions Outcomes Examined for Persons Living with Dementia Key Findings
Interventions to maintain self-care and leisure:
  • Occupation-based
  • Sleep
  • Cognitive
  • Physical exercise
  • Multicomponent interventions
  • Physical functioning
  • Sleep
  • Leisure
  • Social engagement
  • For persons with dementia, evidence is strong for the effect of occupation-based interventions and cognitive interventions on maintaining functional performance.
  • Evidence is strong for physical exercise for improving sleep and physical function.
Supervised home- or community-based exercise programs longer than 3 months
  • Function (basic and instrumental activities of daily living)
  • Falls
  • Hospital readmission
  • For older adults with cognitive impairment, long-term exercise programs improved functional independence compared with usual care.
  • Two randomized trials suggest long-term exercise programs may reduce falls.
Combined cognitive-physical interventions
  • Cognitive function
  • Activities of daily living
  • Mood
  • For persons with dementia, there is a small to medium positive effect of combined cognitive–physical interventions on global cognitive function compared with usual care.
  • There is a moderate to large positive effect of combined cognitive–physical interventions on activities of daily living.
  • There is a small to medium positive effect of combined cognitive–physical interventions on mood.
Dance movement therapy
  • Behavior
  • Social interaction
No studies met the inclusion criteria.
Suggested Citation:"Appendix C: Synthesis of Reviews of Nonpharmacologic Interventions." National Academies of Sciences, Engineering, and Medicine. 2021. Reducing the Impact of Dementia in America: A Decadal Survey of the Behavioral and Social Sciences. Washington, DC: The National Academies Press. doi: 10.17226/26175.
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Author Method Dates of Studies Reviewed Population No. of Studies Included Included Study Designs
Ijaopo, 2017 Systematic review 2008–2017 Persons living with dementia 10
  • Randomized controlled trial (7)
  • Reviews (3)
Garrido et al., 2017 Critical synthesis 2006–2016 Persons living with dementia 28
  • Nonrandomized clinical trial
  • Randomized controlled trial
Dimitriou and Tsolaki, 2017 Systematic review 1998–2013 Persons living with dementia 11 Randomized controlled trial
Anderson et al., 2017 Systematic review 2008–2015 Persons living with dementia 7 Randomized controlled trial
Abraha et al., 2017 Systematic review 1997–2007 Persons living with dementia 3
  • Quasi-randomized controlled trial
  • Randomized controlled trial
Charry-Sanchez et al., 2018 Systematic review 2000–2017 Persons living with dementia, depression, and other conditions 23 (8 on dementia)
  • Quasi-experimental
  • Randomized controlled trial
Suggested Citation:"Appendix C: Synthesis of Reviews of Nonpharmacologic Interventions." National Academies of Sciences, Engineering, and Medicine. 2021. Reducing the Impact of Dementia in America: A Decadal Survey of the Behavioral and Social Sciences. Washington, DC: The National Academies Press. doi: 10.17226/26175.
×
Types of Interventions Outcomes Examined for Persons Living with Dementia Key Findings
  • Therapeutic touch
  • Tailored activity program
  • Lavender oil
  • Music therapy
  • Electroconvulsive therapy
  • Acupressure
  • Reviews of various nonpharmacologic strategies
  • Agitation
  • Behavior
Evidence is limited on the effect of nonpharmacologic interventions on reducing severe agitation.
Prerecorded music alone or in combination with other musical activities Behaviors For persons with dementia, prerecorded music can be effective in reducing behavioral symptoms, including agitation.
Sensory stimulation interventions:
  • Massage
  • Acupuncture
  • Bright light
Sleep disturbances Bright light therapy may help reduce sleeping problems compared with usual care.
Complementary and alternative medicine:
  • Reflexology
  • Aromatherapy
  • Therapeutic touch
  • Foot massage
  • Aromatherapy and hand massage
  • Aromatherapy with donepezil
  • Behavior
  • Pain
Complementary and alternative medicine may reduce behavioral symptoms compared with control conditions.
Simulated presence therapy (audio or video recording)
  • Behaviors
  • Quality of life
Low quality evidence indicates the effects of simulated presence on behavioral outcomes is uncertain.
Animal-assisted therapies
  • Cognition
  • Behavior
  • Mood
  • Physical function
For persons living with dementia, animal–assisted therapy shows promise in short-term management of behaviors, but study designs limit inferences.
Suggested Citation:"Appendix C: Synthesis of Reviews of Nonpharmacologic Interventions." National Academies of Sciences, Engineering, and Medicine. 2021. Reducing the Impact of Dementia in America: A Decadal Survey of the Behavioral and Social Sciences. Washington, DC: The National Academies Press. doi: 10.17226/26175.
×
Author Method Dates of Studies Reviewed Population No. of Studies Included Included Study Designs
Chiu et al., 2018 Systematic review and meta-analysis 1981–2016 Persons living with dementia 11 Randomized controlled trial
Creighton et al., 2013 Systematic review 1989–2012 Persons living with dementia 34
  • Quasi-experimental
  • Randomized controlled trial
Fakhoury et al., 2017 Literature review 2000–2015 Persons living with dementia 6 Randomized controlled trial
Fleiner et al., 2017 Systematic review 1994–2009 Persons living with dementia 5
  • Quasi-experiential
  • Randomized controlled trial
Folkerts et al., 2017 Systematic review and meta-analysis 1981–2016 Persons living with dementia 27 (15 included in meta-analysis)
  • Quasi-experiential
  • Randomized controlled trial
Garcia-Casal et al., 2017 Systematic review and meta-analysis 2003–2014 Persons living with dementia 12
  • Quasi-experiential
  • Randomized controlled trial
Suggested Citation:"Appendix C: Synthesis of Reviews of Nonpharmacologic Interventions." National Academies of Sciences, Engineering, and Medicine. 2021. Reducing the Impact of Dementia in America: A Decadal Survey of the Behavioral and Social Sciences. Washington, DC: The National Academies Press. doi: 10.17226/26175.
×
Types of Interventions Outcomes Examined for Persons Living with Dementia Key Findings
Reality orientation therapy alone or combined with reminiscence therapy or cognitive training
  • Cognition
  • Behavior
  • Depressive symptoms
  • Reality orientation is associated with a moderate effect on cognitive function.
  • Intervention has no effect on behavior or depressive symptoms.
Spaced retrieval:
  • Name–face associations
  • Object–name associations
  • Cue–behavior associations
  • Mixed goals/other
  • Recall
  • Behavior
Spaced-retrieval interventions are viable and may be effective in improving recall and reducing problem behaviors, but more rigorous study designs are needed.
Music therapy Behavior Findings across studies are mixed.
Short-term structured exercise Behavior Structured exercise may reduce problem behaviors. Larger and more rigorous study designs are needed.
Cognitive intervention:
  • Reminiscence therapy
  • Cognitive training
  • Cognitive rehabilitation
  • Cognitive stimulation
  • Multimodal interventions
  • Cognition
  • Global scales for dementia symptoms
  • Quality of life
  • Behavior
  • Mood
  • Physical function
  • Cognitive interventions moderately improve global cognition, autobiographical memory, and behaviors.
  • Cognitive interventions are associated with small improvements in quality of life.
Computer-based cognitive training:
  • Cognitive recreation
  • Cognitive rehabilitation
  • Cognitive stimulation
  • Cognitive training
Cognition
  • Computer-based cognitive training is associated with moderate improvements in cognition and anxiety.
  • Computer-based cognitive training is associated with a small reduction in depression.
  • Computer-based cognitive training is associated with no effect on activities of daily living.
Suggested Citation:"Appendix C: Synthesis of Reviews of Nonpharmacologic Interventions." National Academies of Sciences, Engineering, and Medicine. 2021. Reducing the Impact of Dementia in America: A Decadal Survey of the Behavioral and Social Sciences. Washington, DC: The National Academies Press. doi: 10.17226/26175.
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Author Method Dates of Studies Reviewed Population No. of Studies Included Included Study Designs
Jutkowitz et al., 2016 Systematic review and meta-analysis 1999–2014 Persons living with dementia 19 Randomized controlled trial
Klimova et al., 2017 Literature review 2010–2014 Persons living with dementia 6
  • Quasi-experiential
  • Randomized controlled trial
Woods et al., 2018 Systematic review and meta-analysis 1987–2016 Persons with dementia 22 (16 included in meta-analysis) Randomized controlled trial
Levy et al., 2017 Systematic review 1995–2015 Older adults 40 (39 on dementia)
  • Quasi-experiential
  • Randomized controlled trial
Suggested Citation:"Appendix C: Synthesis of Reviews of Nonpharmacologic Interventions." National Academies of Sciences, Engineering, and Medicine. 2021. Reducing the Impact of Dementia in America: A Decadal Survey of the Behavioral and Social Sciences. Washington, DC: The National Academies Press. doi: 10.17226/26175.
×
Types of Interventions Outcomes Examined for Persons Living with Dementia Key Findings
Care-delivery interventions:
  • Dementia care mapping
  • Person centered care
  • Clinical protocols
  • Emotion-oriented care
  • Staff education
  • Agitation
  • Aggression
  • Behaviors
  • Psychotropic use
  • Depression
Evidence was insufficient to draw conclusions on the effect of care-delivery interventions on agitation/aggression or problem behaviors.
Dancing therapy Any outcomes Limited data suggest dancing therapy may positively impact cognition, physical function, and mood.
Reminiscence therapy
  • Quality of life
  • Communication
  • Depression
  • Cognition
Heterogeneity of study designs makes inferences challenging, but overall, effects are small and inconsistent.
Complementary and alternative medicine:
  • Acupressure
  • Aromatherapy
  • Massage
  • Therapeutic touch
  • Reflexology
  • Natural products
  • Japanese medicine
  • Osteopathy
  • Healing touch
  • Agitation
  • Delirium
  • Complementary and alternative medicine had a small effect on reducing agitation.
  • Conclusions could not be drawn regarding the effect of complementary and alternative medicine on delirium.
Suggested Citation:"Appendix C: Synthesis of Reviews of Nonpharmacologic Interventions." National Academies of Sciences, Engineering, and Medicine. 2021. Reducing the Impact of Dementia in America: A Decadal Survey of the Behavioral and Social Sciences. Washington, DC: The National Academies Press. doi: 10.17226/26175.
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Author Method Dates of Studies Reviewed Population No. of Studies Included Included Study Designs
Morrin et al., 2018 Systematic review 1995–2017 Persons living with Lewy body dementia 15 Quasi-experiential
Nyman et al., 2018 Systematic review 2003–2015 Persons living with dementia 9 (reported in 19 articles) Randomized controlled trial
O’Caoimh et al., 2019 Systematic review and meta-analysis 1992–2018 Persons living with mild cognitive impairment or dementia 48
  • Quasi-experiential
  • Randomized controlled trial
Zhang et al., 2017 Systematic review and meta-analysis 1987–2016 Persons living with dementia 34
  • Controlled clinical trial
  • Randomized controlled trial

SOURCE: Adapted from Gaugler et al., 2020. [commissioned paper]

Suggested Citation:"Appendix C: Synthesis of Reviews of Nonpharmacologic Interventions." National Academies of Sciences, Engineering, and Medicine. 2021. Reducing the Impact of Dementia in America: A Decadal Survey of the Behavioral and Social Sciences. Washington, DC: The National Academies Press. doi: 10.17226/26175.
×
Types of Interventions Outcomes Examined for Persons Living with Dementia Key Findings
Nonpharmacologic interventions:
  • Deep brain stimulation
  • Transcranial direct current stimulation
  • Exercise
  • Electroconvulsive therapy
  • Repetitive transcranial magnetic stimulation
  • Cognition
  • Physical function
  • Quality of life
  • Behavior
  • Mood
  • Evidence for the effect of nonpharmacologic interventions for persons with Lewy body dementia is inconclusive.
  • More rigorous study designs are needed.
Behavior change (e.g., goal setting, social support, credible source) to promote physical activity
  • Participation in physical activity
  • Physical activity
  • Adherence
  • Some behavior change strategies are associated with increased participation in physical activity.
  • More rigorous study designs are needed.
Nonpharmacologic interventions:
  • Light therapy
  • Multimodal
  • Transcutaneous electrical nerve stimulation
  • Exercise
  • Acupressure/acupuncture
  • Cognitive-behavioral therapy
  • Sleep
  • Cognition
  • Mood
  • Behavior
  • Quality of life
  • Nonpharmacologic interventions may significantly improve sleep efficiency outcomes compared with control conditions, but overall, evidence is insufficient.
  • More rigorous study designs are needed.
Music therapy
  • Behavior
  • Cognitive function
  • Depression
  • Anxiety
  • Quality of life
  • Music therapy compared with inactive control condition associated with reductions in behaviors and anxiety.
  • The effect of music therapy on cognitive function, depression, and quality of life is unclear.
Suggested Citation:"Appendix C: Synthesis of Reviews of Nonpharmacologic Interventions." National Academies of Sciences, Engineering, and Medicine. 2021. Reducing the Impact of Dementia in America: A Decadal Survey of the Behavioral and Social Sciences. Washington, DC: The National Academies Press. doi: 10.17226/26175.
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REFERENCES

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Suggested Citation:"Appendix C: Synthesis of Reviews of Nonpharmacologic Interventions." National Academies of Sciences, Engineering, and Medicine. 2021. Reducing the Impact of Dementia in America: A Decadal Survey of the Behavioral and Social Sciences. Washington, DC: The National Academies Press. doi: 10.17226/26175.
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Suggested Citation:"Appendix C: Synthesis of Reviews of Nonpharmacologic Interventions." National Academies of Sciences, Engineering, and Medicine. 2021. Reducing the Impact of Dementia in America: A Decadal Survey of the Behavioral and Social Sciences. Washington, DC: The National Academies Press. doi: 10.17226/26175.
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Suggested Citation:"Appendix C: Synthesis of Reviews of Nonpharmacologic Interventions." National Academies of Sciences, Engineering, and Medicine. 2021. Reducing the Impact of Dementia in America: A Decadal Survey of the Behavioral and Social Sciences. Washington, DC: The National Academies Press. doi: 10.17226/26175.
×

Smallfield, S., and Heckenlaible, C. (2017). Effectiveness of occupational therapy interventions to enhance occupational performance for adults with Alzheimer’s disease and related major neurocognitive disorders: A systematic review. American Journal of Occupational Therapy, 71(5), 7105180010p–7105180010p. https://doi.org/10.5014/ajot.2017.024752

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Suggested Citation:"Appendix C: Synthesis of Reviews of Nonpharmacologic Interventions." National Academies of Sciences, Engineering, and Medicine. 2021. Reducing the Impact of Dementia in America: A Decadal Survey of the Behavioral and Social Sciences. Washington, DC: The National Academies Press. doi: 10.17226/26175.
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As the largest generation in U.S. history - the population born in the two decades immediately following World War II - enters the age of risk for cognitive impairment, growing numbers of people will experience dementia (including Alzheimer's disease and related dementias). By one estimate, nearly 14 million people in the United States will be living with dementia by 2060. Like other hardships, the experience of living with dementia can bring unexpected moments of intimacy, growth, and compassion, but these diseases also affect people's capacity to work and carry out other activities and alter their relationships with loved ones, friends, and coworkers. Those who live with and care for individuals experiencing these diseases face challenges that include physical and emotional stress, difficult changes and losses in their relationships with life partners, loss of income, and interrupted connections to other activities and friends. From a societal perspective, these diseases place substantial demands on communities and on the institutions and government entities that support people living with dementia and their families, including the health care system, the providers of direct care, and others.

Nevertheless, research in the social and behavioral sciences points to possibilities for preventing or slowing the development of dementia and for substantially reducing its social and economic impacts. At the request of the National Institute on Aging of the U.S. Department of Health and Human Services, Reducing the Impact of Dementia in America assesses the contributions of research in the social and behavioral sciences and identifies a research agenda for the coming decade. This report offers a blueprint for the next decade of behavioral and social science research to reduce the negative impact of dementia for America's diverse population. Reducing the Impact of Dementia in America calls for research that addresses the causes and solutions for disparities in both developing dementia and receiving adequate treatment and support. It calls for research that sets goals meaningful not just for scientists but for people living with dementia and those who support them as well.

By 2030, an estimated 8.5 million Americans will have Alzheimer's disease and many more will have other forms of dementia. Through identifying priorities social and behavioral science research and recommending ways in which they can be pursued in a coordinated fashion, Reducing the Impact of Dementia in America will help produce research that improves the lives of all those affected by dementia.

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