Nonpharmacological Interventions to Reduce Behavioral and Psychological Symptoms of Dementia: A Systematic Review

Alexandra Martini de Oliveira, Marcia Radanovic, Patrícia Cotting Homem de Mello, Patrícia Cardoso Buchain, Adriana Dias Barbosa Vizzotto, Diego L Celestino, Florindo Stella, Catherine V Piersol, Orestes V Forlenza, Alexandra Martini de Oliveira, Marcia Radanovic, Patrícia Cotting Homem de Mello, Patrícia Cardoso Buchain, Adriana Dias Barbosa Vizzotto, Diego L Celestino, Florindo Stella, Catherine V Piersol, Orestes V Forlenza

Abstract

Introduction: Behavioral and psychological symptoms of dementia (BPSD) are defined as a group of symptoms of disturbed perceptive thought content, mood, or behavior that include agitation, depression, apathy, repetitive questioning, psychosis, aggression, sleep problems, and wandering. Care of patients with BPSD involves pharmacological and nonpharmacological interventions. We reviewed studies of nonpharmacological interventions published in the last 10 years.

Methods: We performed a systematic review in Medline and Embase databases, in the last 10 years, until June 2015. Key words used were (1) non-pharmacological interventions, (2) behavioral symptoms, (3) psychological symptoms, and (4) dementia.

Results: We included 20 studies published in this period. Among these studies, program activities were more frequent (five studies) and the symptoms more responsive to the interventions were agitation.

Discussion: Studies are heterogeneous in many aspects, including size sample, intervention, and instruments of measures.

Conclusion: Nonpharmacological interventions are able to provide positive results in reducing symptoms of BPSD. Most studies have shown that these interventions have important and significant efficacy.

References

    1. Trivedi D., Goodman C., Dickinson A., et al. A protocol for a systematic review of research on managing behavioural and psychological symptoms in dementia for community-dwelling older people: evidence mapping and syntheses. Systematic Reviews. 2013;2, article 70 doi: 10.1186/2046-4053-2-70.
    1. Kales H. C., Kim H. M., Zivin K., et al. Risk of mortality among individual antipsychotics in patients with dementia. The American Journal of Psychiatry. 2012;169(1):71–79. doi: 10.1176/appi.ajp.2011.11030347.
    1. Lyketsos C. G., Lopez O., Jones B., Fitzpatrick A. L., Breitner J., DeKosky S. Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the cardiovascular health study. The Journal of the American Medical Association. 2002;288(12):1475–1483. doi: 10.1001/jama.288.12.1475.
    1. Hersch E. C., Falzgraf S. Management of the behavioral and psychological symptoms of dementia. Clinical Interventions in Aging. 2007;2(4):611–621.
    1. Woods D. L., Dimond M. The effect of therapeutic touch on agitated behavior and cortisol in persons with Alzheimer's disease. Biological Research for Nursing. 2002;4(2):104–114. doi: 10.1177/1099800402238331.
    1. Paulsen J. S., Salmon D. P., Thal L. J., et al. Incidence of and risk factors for hallucinations and delusions in patients with probable AD. Neurology. 2000;54(10):1965–1971. doi: 10.1212/WNL.54.10.1965.
    1. Haupt M., Kurz A., Jänner M. A 2-year follow-up of behavioural and psychological symptoms in Alzheimer's disease. Dementia and Geriatric Cognitive Disorders. 2000;11(3):147–152. doi: 10.1159/000017228.
    1. Finkel S. Introduction to behavioural and psychological symptoms of dementia (BPSD) International Journal of Geriatric Psychiatry. 2000;15(supplement 1):S2–S4. doi: 10.1002/(sici)1099-1166(200004)15:1lt;s2::aid-gps159>;2-3.
    1. Schneider L. S., Dagerman K., Insel P. S. Efficacy and adverse effects of atypical antipsychotics for dementia: meta-analysis of randomized, placebo-controlled trials. American Journal of Geriatric Psychiatry. 2006;14(3):191–210. doi: 10.1097/01.jgp.0000200589.01396.6d.
    1. Kar N. Behavioral and psychological symptoms of dementia and their management. Indian Journal of Psychiatry. 2009;51(supplement 1):S77–S86.
    1. O'Connor C. M., Clemson L., Brodaty H., Jeon Y. H., Mioshi E., Gitlin L. N. Use of the Tailored Activities Program to reduce neuropsychiatric behaviors in dementia: an Australian protocol for a randomized trial to evaluate its effectiveness. International Psychogeriatrics. 2014;26(5):857–869. doi: 10.1017/s1041610214000040.
    1. Kales H. C., Valenstein M., Kim H. M., et al. Mortality risk in patients with dementia treated with antipsychotics versus other psychiatric medications. The American Journal of Psychiatry. 2007;164(10):1568–1576. doi: 10.1176/appi.ajp.2007.06101710.
    1. Ballard C., Ziabreva I., Perry R., et al. Differences in neuropathologic characteristics across the Lewy body dementia spectrum. Neurology. 2006;67(11):1931–1934. doi: 10.1212/.
    1. Ballard C., Hanney M. L., Theodoulou M., et al. The dementia antipsychotic withdrawal trial (DART-AD): long-term follow-up of a randomised placebo-controlled trial. The Lancet Neurology. 2009;8(2):151–157. doi: 10.1016/s1474-4422(08)70295-3.
    1. Lowery D., Cerga-Pashoja A., Iliffe S., et al. The effect of exercise on behavioural and psychological symptoms of dementia: the EVIDEM-E randomised controlled clinical trial. International Journal of Geriatric Psychiatry. 2014;29(8):819–827. doi: 10.1002/gps.4062.
    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Arlington, Va, USA: American Psychiatric Publishing; 2013.
    1. Royal College of Nursing. Dementia: Supporting People with Dementia and Their Careers in Health and Social Care. London, UK: National Institute for Health and Clinical Excellence; 2006. .
    1. American Geriatrics Society. Choosing Wisely, An Initiative of the ABIM Foundation. Five Things Physicians and Patients Should Question. American Geriatrics Society; 2013.
    1. Cohen-Mansfield J. Nonpharmacologic interventions for inappropriate behaviors in dementia: a review, summary, and critique. The American Journal of Geriatric Psychiatry. 2001;9(4):361–381. doi: 10.1097/00019442-200111000-00005.
    1. Gill S. S., Bronskill S. E., Normand S.-L. T., et al. Antipsychotic drug use and mortality in older adults with dementia. Annals of Internal Medicine. 2007;146(11):775–786. doi: 10.7326/0003-4819-146-11-200706050-00006.
    1. Yang M. H., Lin L. C., Wu S. C., Chiu J. H., Wang P. N., Lin J. G. Comparison of the efficacy of aroma-acupressure and aromatherapy for the treatment of dementia-associated agitation. BMC Complementary and Alternative Medicine. 2015;15, article 93 doi: 10.1186/s12906-015-0612-9.
    1. Cerga-Pashoja A., Lowery D., Bhattacharya R., et al. Evaluation of exercise on individuals with dementia and their carers: a randomised controlled trial. Trials. 2010;11, article 53 doi: 10.1186/1745-6215-11-53.
    1. Chen R.-C., Liu C.-L., Lin M.-H., et al. Non-pharmacological treatment reducing not only behavioral symptoms, but also psychotic symptoms of older adults with dementia: a prospective cohort study in Taiwan. Geriatrics and Gerontology International. 2014;14(2):440–446. doi: 10.1111/ggi.12126.
    1. Holmes C., Knights A., Dean C., Hodkinson S., Hopkins V. Keep music live: music and the alleviation of apathy in dementia subjects. International Psychogeriatrics. 2006;18(4):623–630. doi: 10.1017/s1041610206003887.
    1. Svansdottir H. B., Snaedal J. Music therapy in moderate and severe dementia of Alzheimer's type: a case–control study. International Psychogeriatrics. 2006;18(4):613–621. doi: 10.1017/s1041610206003206.
    1. Garland K., Beer E., Eppingstall B., O'Connor D. W. A comparison of two treatments of agitated behavior in nursing home residents with dementia: simulated family presence and preferred music. The American Journal of Geriatric Psychiatry. 2007;15(6):514–521. doi: 10.1097/01.jgp.0000249388.37080.b4.
    1. Lin P. W.-K., Chan W.-C., Ng B. F.-L., Lam L. C.-W. Efficacy of aromatherapy (Lavandula angustifolia) as an intervention for agitated behaviours in Chinese older persons with dementia: a cross-over randomized trial. International Journal of Geriatric Psychiatry. 2007;22(5):405–410. doi: 10.1002/gps.1688.
    1. Gitlin L. N., Winter L., Burke J., Chemett N., Dennis M. P., Hauck W. W. Tailored activities to manage neuropsychiatric behaviors in persons with dementia and reduce caregiver burden: a randomized pilot study. The American Journal of Geriatric Psychiatry. 2008;16(3):229–239. doi: 10.1097/01.jgp.0000300629.35408.94.
    1. Burns A., Allen H., Tomenson B., Duignan D., Byrne J. Bright light therapy for agitation in dementia: a randomized controlled trial. International Psychogeriatrics. 2009;21(4):711–721. doi: 10.1017/s1041610209008886.
    1. van der Ploeg E. S., Eppingstall B., O'Connor D. W. The study protocol of a blinded randomised-controlled cross-over trial of lavender oil as a treatment of behavioural symptoms in dementia. BMC Geriatrics. 2010;10(1, article 49) doi: 10.1186/1471-2318-10-49.
    1. Burns A., Perry E., Holmes C., et al. A double-blind placebo-controlled randomized trial of Melissa officinalis oil and donepezil for the treatment of agitation in Alzheimer's disease. Dementia and Geriatric Cognitive Disorders. 2011;31(2):158–164. doi: 10.1159/000324438.
    1. Kolanowski A., Litaker M., Buettner L., Moeller J., Costa P. T., Jr. A randomized clinical trial of theory-based activities for the behavioral symptoms of dementia in nursing home residents. Journal of the American Geriatrics Society. 2011;59(6):1032–1041. doi: 10.1111/j.1532-5415.2011.03449.x.
    1. Sung H.-C., Lee W.-L., Li T.-L., Watson R. A group music intervention using percussion instruments with familiar music to reduce anxiety and agitation of institutionalized older adults with dementia. International Journal of Geriatric Psychiatry. 2012;27(6):621–627. doi: 10.1002/gps.2761.
    1. Brunelle-Hamann L., Thivierge S., Simard M. Impact of a cognitive rehabilitation intervention on neuropsychiatric symptoms in mild to moderate Alzheimer's disease. Neuropsychological Rehabilitation. 2015;25(5):677–707. doi: 10.1080/09602011.2014.964731.
    1. Neville C., Henwood T., Beattie E., Fielding E. Exploring the effect of aquatic exercise on behaviour and psychological well-being in people with moderate to severe dementia: a pilot study of the Watermemories Swimming Club. Australasian Journal on Ageing. 2014;33(2):124–127. doi: 10.1111/ajag.12076.
    1. Dowling G. A., Graf C. L., Hubbard E. M., Luxenberg J. S. Light treatment for neuropsychiatric behaviors in Alzheimer's disease. Western Journal of Nursing Research. 2007;29(8):961–975. doi: 10.1177/0193945907303083.
    1. Graff M. J. L., Vernooij-Dassen M. J. M., Thijssen M., Dekker J., Hoefnagels W. H. L., Rikkert M. G. M. O. Community based occupational therapy for patients with dementia and their care givers: randomised controlled trial. British Medical Journal. 2006;333(7580):1196–1199. doi: 10.1136/.
    1. Brooker D. J., Woolley R. J., Lee D. Enriching opportunities for people living with dementia in nursing homes: an evaluation of a multi-level activity-based model of care. Aging and Mental Health. 2007;11(4):361–370. doi: 10.1080/13607860600963679.
    1. Fraker J., Kales H. C., Blazek M., Kavanagh J., Gitlin L. N. The role of the occupational therapist in the management of neuropsychiatric symptoms of dementia in clinical settings. Occupational Therapy in Health Care. 2014;28(1):4–20. doi: 10.3109/07380577.2013.867468.
    1. Gerdner L. A. Individualized music for dementia: evolution and application of evidence-based protocol. World Journal of Psychiatry. 2012;2(2):26–32. doi: 10.5498/wjp.v2.i2.26.
    1. Bahar-Fuchs A., Clare L., Woods B. Cognitive training and cognitive rehabilitation for persons with mild to moderate dementia of the Alzheimer's or vascular type: a review. Alzheimer's Research and Therapy. 2013;5(4, article 35) doi: 10.1186/alzrt189.
    1. Gerdner L. A. Music, art, and recreational therapies in the treatment of behavioral and psychological symptoms of dementia. International Psychogeriatrics. 2000;12(1):359–366.
    1. Gerdner L. A. Effects of individualized versus classical ‘relaxation’ music on the frequency of agitation in elderly persons with Alzheimer's disease and related disorders. International Psychogeriatrics. 2000;12(1):49–65. doi: 10.1017/s1041610200006190.
    1. Ryu S.-H., Katona C., Rive B., Livingston G. Persistence of and changes in neuropsychiatric symptoms in Alzheimer disease over 6 months: the LASER–AD study. The American Journal of Geriatric Psychiatry. 2005;13(11):976–983. doi: 10.1097/00019442-200511000-00008.
    1. Livingston G., Johnston K., Katona C., Paton J., Lyketsos C. G. Systematic review of psychological approaches to the management of neuropsychiatric symptoms of dementia. The American Journal of Psychiatry. 2005;162(11):1996–2021. doi: 10.1176/appi.ajp.162.11.1996.
    1. O'Connor D. W., Ames D., Gardner B., King M. Psychosocial treatments of behavior symptoms in dementia: a systematic review of reports meeting quality standards. International Psychogeriatrics. 2009;21(2):225–240. doi: 10.1017/s1041610208007588.
    1. O'Connor D. W., Ames D., Gardner B., King M. Psychosocial treatments of psychological symptoms in dementia: a systematic review of reports meeting quality standards. International Psychogeriatrics. 2009;21(2):241–251. doi: 10.1017/s1041610208008223.
    1. Gitlin L. N., Hodgson N., Jutkowitz E., Pizzi L. The cost-effectiveness of a nonpharmacologic intervention for individuals with dementia and family caregivers: the tailored activity program. The American Journal of Geriatric Psychiatry. 2010;18(6):510–519. doi: 10.1097/jgp.0b013e3181c37d13.

Source: PubMed

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