The DOI matches its Crossref record; 228 of the 229 references it cites were found in a registry or an index.
Nonpharmacological Therapies in Alzheimer’s Disease: A Systematic Review of Efficacy
Open accessAbstract
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 (indicating dementia) had to be present or presumed in at least 80% of the subjects. Evidence tables, meta-analysis and summaries of results were elaborated by the first author and reviewed by author subgroups. Methods for rating level of evidence and grading practice recommendations were adapted from the Oxford Center for Evidence-Based Medicine. RESULTS: Grade A treatment recommendation was achieved for institutionalization delay (multicomponent interventions for the caregiver, CG). Grade B recommendation was reached for the person with dementia (PWD) for: improvement in cognition (cognitive training, cognitive stimulation, multicomponent interventions for the PWD); activities of daily living (ADL) (ADL training, multicomponent interventions for the PWD); behavior (cognitive stimulation, multicomponent interventions for the PWD, behavioral interventions, professional CG training); mood (multicomponent interventions for the PWD); QoL (multicomponent interventions for PWD and CG) and restraint prevention (professional CG training); for the CG, grade B was also reached for: CG mood (CG education, CG support, multicomponent interventions for the CG); CG psychological well-being (cognitive stimulation, multicomponent interventions for the CG); CG QoL (multicomponent interventions for PWD and CG). CONCLUSION: NPTs emerge as a useful, versatile and potentially cost-effective approach to improve outcomes and QoL in ADRD for both the PWD and CG.
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“Indeed, research shows a positive correlation between increased physical activity, cognitive training, improved nutrition, and slowing cognitive and functional decline and intensity of BPSD.”
From Alzheimer's Disease: Treatment Strategies and Their Limitations. (2022) · cites this paper as [170]
In the citing paper
“Only multicomponent interventions have been shown to be effective in preventing institutionalisation.11,12”
In the citing paper
“However, preliminary results indicate that CS may improve QoL and well-being of caregivers of people with AD and dementia (69, 70, 74).”
From The Multidisciplinary Approach to Alzheimer’s Disease and Dementia. A Narrative Review of Non-Pharmacological Treatment (2018) · cites this paper as [70]
In the citing paper
“Most RCTs showed no effect of CT on other outcomes, but their low quality impede any solid conclusion (70–72, 74, 77).”
From The Multidisciplinary Approach to Alzheimer’s Disease and Dementia. A Narrative Review of Non-Pharmacological Treatment (2018) · cites this paper as [70]
In the citing paper
“Several studies reported an improvement of general cognitive functioning in patients with mild-to-moderate dementia after CS sessions of variable length (69–74).”
From The Multidisciplinary Approach to Alzheimer’s Disease and Dementia. A Narrative Review of Non-Pharmacological Treatment (2018) · cites this paper as [70]
In the citing paper
“Music therapy and behavioral management techniques seem to cause a short-term reduction of BPSD, but long-term efficacy is unclear.”
From The Multidisciplinary Approach to Alzheimer’s Disease and Dementia. A Narrative Review of Non-Pharmacological Treatment (2018) · cites this paper as [70]
In the citing paper
“Potential benefits of these interventions have been documented, but the strength of evidence is overall low and the great heterogeneity in terms of type of intervention, follow-up duration, type of outcome measures hamper comparison across studies.”
From The Multidisciplinary Approach to Alzheimer’s Disease and Dementia. A Narrative Review of Non-Pharmacological Treatment (2018) · cites this paper as [70]
In the citing paper
“In particular, there are no conclusive results for validation and reminiscence therapy, the effectiveness of light therapy is not clear, aromatherapy is better than no treatment.”
From The Multidisciplinary Approach to Alzheimer’s Disease and Dementia. A Narrative Review of Non-Pharmacological Treatment (2018) · cites this paper as [70]
In the citing paper
“The small body of evidence for other sensory interventions, such as massage and touch therapy, suggests they could be viable treatment options, especially given the ease of implementation and minimal training involved.”
From The Multidisciplinary Approach to Alzheimer’s Disease and Dementia. A Narrative Review of Non-Pharmacological Treatment (2018) · cites this paper as [70]
In the citing paper
“No effect has been documented for acupuncture and transcutaneous electrical nerve stimulation.”
From The Multidisciplinary Approach to Alzheimer’s Disease and Dementia. A Narrative Review of Non-Pharmacological Treatment (2018) · cites this paper as [70]
In the citing paper
“Some reports indicate the NPT to BPSD to be potentially cost-effective (70, 99, 106), but further research is needed on this point.”
From The Multidisciplinary Approach to Alzheimer’s Disease and Dementia. A Narrative Review of Non-Pharmacological Treatment (2018) · cites this paper as [70]
In the citing paper
“Actually, some systematic reviews demonstrated that multicomponent interventions were more effective than single activities in improving general well-being of both persons with dementia and their caregivers (70, 175), and in hospitalized older adults with cognitive impairment (176, 177).”
From The Multidisciplinary Approach to Alzheimer’s Disease and Dementia. A Narrative Review of Non-Pharmacological Treatment (2018) · cites this paper as [70]
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“Nonpharmacological therapies have emerged as a useful approach for improving behavioral disturbances.(41) Callahan et al(44,45) reported a collaborative care model for the management of behavioral and psychiatric symptoms.”
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“responses to interventions from caregivers with high levels of depression and anxiety at baseline.(10) For this mostly asymptomatic group of caregivers in our study, perhaps follow-up at regular intervals provided enough information and support to prevent the emergence of depressive symptoms and maintain good life qua…”
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Blom, M., Bosmans, J. E., Cuijpers, P. J., Zarit, S. H., & Pot, A. M. (2013) · BMC Psychiatry · doi:10.1186/1471-244x-13-17 · Cited by 60
“A recent review shows that psychological therapies and psychosocial interventions may be a potentially cost effective approach to improve outcomes and quality of life in both people with dementia and their family caregivers [10].”
BackgroundChange in quality of life of people with dementia recently admitted to long‐term care facilities
Beerens, H. C., Zwakhalen, S. M. G., Verbeek, H., Ruwaard, D., Ambergen, A. W., Leino‐Kilpi, H., Stephan, A., Zabalegui, A., Soto, M. E., Saks, K., et al. (2014) · Journal of Advanced Nursing · doi:10.1111/jan.12570 · Cited by 58
Silva, A. R., Pinho, M. S., Macedo, L., Moulin, C. J. A., Caldeira, S., & Firmino, H. (2017) · International Psychogeriatrics · doi:10.1017/s104161021600243x · Cited by 58
Nickel, F., Barth, J., & Kolominsky-Rabas, P. L. (2018) · BMC Geriatrics · doi:10.1186/s12877-018-0751-1 · Cited by 58
“Implications for future research There is evidence on the effectiveness of multicomponent psychosocial interventions on the maintenance of caregivers’ psychological health [55] and delayed institutionalization of PwDs [12].”
BackgroundOptimal nonpharmacological management of agitation in Alzheimer’s disease: challenges and solutions
Millán-Calentí, J. C., Lorenzo‐López, L., Alonso-Búa, B., de Labra, C., González‐Abraldes, I., & Maseda, A. (2016) · Clinical Interventions in Aging · doi:10.2147/cia.s69484 · Cited by 58
“12,13 Overall, well-conducted, evidence-based studies on nonpharmacological interventions are lacking.”
Mao, H., Chang, L., Tsai, A. Y., Huang, W. W., Tang, L.-Y., Lee, H.-J., Sun, Y., Chen, T., Lin, K.-N., Wang, P., et al. (2018) · Age and Ageing · doi:10.1093/ageing/afy021 · Cited by 58
Alzheimer's Patient Familial Caregivers: A Review of Burden and Interventions
Wennberg, A. M. V., Dye, C. J., Streetman-Loy, B., & Pham, H. (2015) · Health & Social Work · doi:10.1093/hsw/hlv062 · Cited by 57
Non-Pharmacological Treatment in People With Cognitive Impairment
Straubmeier, M., Behrndt, E.-M., Seidl, H., Özbe, D., Luttenberger, K., & Graessel, E. (2017) · Deutsches Ärzteblatt international · doi:10.3238/arztebl.2017.0815 · Cited by 56
“The findings of 2 recent reviews, however, show that there is currently no scientifically tested care plan for day care centers (3, 5) with specific aims and a structured instruction manual.”
BackgroundChristie, H. L., Martin, J. L., Connor, J., Tange, H. J., Verhey, F. R. J., de Vugt, M. E., & Orrell, M. W. (2019) · Internet Interventions · doi:10.1016/j.invent.2019.100260 · Cited by 56
“(2015)) are often more effective than interventions focused on one area alone (Olazarán et al., 2010).”
BackgroundFörster, S., Buschert, V. C., Teipel, S. J., Friese, U., Buchholz, H.-G., Drzezga, A., Hampel, H., Bartenstein, P., & Buerger, K. (2011) · Journal of Alzheimer's Disease · doi:10.3233/jad-2011-0025 · Cited by 54
“Beneficial effects of interventions on cognitive decline are reported in subjects with preclinical cognitive impairment (see review [4]) or mild-to-moderate stages of dementia (see meta-analyses [5, 6]).”
Efficacy of cognitive stimulation therapy for older adults with vascular dementia
Piras, F., Carbone, E., Faggian, S., Salvalaio, E., Gardini, S., & Borella, E. (2017) · Dementia & Neuropsychologia · doi:10.1590/1980-57642016dn11-040014 · Cited by 54
Multistimulation Group Therapy in Alzheimer’s Disease Promotes Changes in Brain Functioning
Baglio, F., Griffanti, L., Saibene, F. L., Ricci, C., Alberoni, M., Critelli, R., Villanelli, F., Fioravanti, R., Mantovani, F., D’amico, A., et al. (2014) · Neurorehabilitation and neural repair · doi:10.1177/1545968314532833 · Cited by 56
“This kind of therapy would be also the most appropriate for the unique profile of each person with AD, even when performed in small groups.(21,22) In the past 13 years, our group has developed a multidimensional approach—Multidimensional Stimulation Therapy (MST).”
BackgroundEffects of Lexical–Semantic Treatment on Memory in Early Alzheimer Disease
Jelcic, N., Cagnin, A., Meneghello, F., Turolla, A., Ermani, M., & Dam, M. (2012) · Neurorehabilitation and neural repair · doi:10.1177/1545968312440146 · Cited by 54
Does Digital Gaming Enable Healthy Aging for Community-Dwelling People With Dementia?
Cutler, C., Hicks, B., & Innes, A. (2015) · Games and Culture · doi:10.1177/1555412015600580 · Cited by 57
Caregiver burden, health utilities, and institutional service use in Alzheimer's disease
Miller, E. A., Rosenheck, R. A., & Schneider, L. S. S. (2011) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.2730 · Cited by 57
“…consumer direction, service integration, chronic disease management, and importantly, evaluation and improvement of programs such as these (Pusey and Richards, 2001; Thompson et al., 2007; Martín‐Carrasco et al., 2009; Miller et al., 2009a; Tompkins and Bell, 2009; Olazarán et al., 2010).”
BackgroundFernández‐Calvo, B., Contador, I., Ramos, F., Olazarán, J., Mograbi, D. C., & Morris, R. G. (2014) · Neuropsychological Rehabilitation · doi:10.1080/09602011.2014.948461 · Cited by 53
Surr, C., Griffiths, A. W., & Kelley, R. (2018) · Clinical Interventions in Aging · doi:10.2147/cia.s138836 · Cited by 52
“16 Poor intervention delivery, including poor adherence to protocols, is a common barrier for implementation of psychosocial interventions, 16 and the particular difficulties of implementing interventions in care homes are well established.”
Li, B., Tang, H., He, G., Jin, Z., He, Y., Huang, P., He, N., & Chen, S. (2022) · Alzheimer s & Dementia · doi:10.1002/alz.12658 · Cited by 52
Luttenberger, K., Hofner, B., & Graessel, E. (2012) · BMC Neurology · doi:10.1186/1471-2377-12-151 · Cited by 52
“However, the greatest effects of non-drug therapies in the treatment of Alzheimer’s dementia are achieved with multimodal therapy [1,4,5].”
BackgroundRehabilitation to live better with dementia
Maki, Y., Sakurai, T., Okochi, J., Yamaguchi, H., & Toba, K. (2018) · Geriatrics and gerontology international/Geriatrics & gerontology international · doi:10.1111/ggi.13517 · Cited by 59
Suominen, M. H., Puranen, T. M., Jyväkorpi, S. K., Eloniemi-Sulkava, U. R., Kautiainen, H., Siljamäki-Ojansuu, U., & Pitkälä, K. H. (2015) · The journal of nutrition health & aging · doi:10.1007/s12603-015-0558-0 · Cited by 51
“Nonpharmacological interventions have had promising effects on the health-related quality of life (HRQoL) of people with AD (6), but the potential of nutrition interventions in this group has received less attention.”
Hendriks, I., Meiland, F. J. M., Gerritsen, D. L., & Dröes, R. (2018) · International Psychogeriatrics · doi:10.1017/s1041610218000959 · Cited by 51
“Several studies have shown that psychosocial interventions, such as cognitive stimulation therapy, reminiscence, and physical exercise can be beneficial for people with dementia (Olazarán et al., 2010).”
BackgroundCognitive stimulation program in mild cognitive impairment A randomized controlled trial
Gómez‐Soria, I., Peralta, P., & Plo, F. (2020) · Dementia & Neuropsychologia · doi:10.1590/1980-57642020dn14-020003 · Cited by 51
Longitudinal Predictors of Self-Rated Health and Mortality in Older Adults
Wagner, D. C., & Short, J. L. (2014) · Preventing Chronic Disease · doi:10.5888/pcd11.130241 · Cited by 52
“Cognitive training and cognitive stimulation have demonstrated improved attention, learning, and memory functioning in healthy older adults and those with dementia (27,28), and preliminary findings suggest that transcranial direct current stimulation (29) and deep brain stimulation may sustain or even improve memory f…”
Kim, M.-J., Han, C.-W., Min, K.-Y., Cho, C.-Y., Lee, C.-W., Ogawa, Y., Mori, E., & Kohzuki, M. (2016) · Dementia and Geriatric Cognitive Disorders Extra · doi:10.1159/000446508 · Cited by 51
Sacuiu, S. F. (2016) · Handbook of clinical neurology · doi:10.1016/b978-0-12-802973-2.00008-2 · Cited by 57
Can a Virtual Nature Experience Reduce Anxiety and Agitation in People With Dementia?
Reynolds, L., Rodiek, S. D., Lininger, M. R., & McCulley, M. A. (2018) · Journal of Housing for the Elderly · doi:10.1080/02763893.2018.1431583 · Cited by 51
Updated meta-review of evidence on support for carers
Thomas, S., Dalton, J., Harden, M., Eastwood, A. J., & Parker, G. M. (2017) · Health Services and Delivery Research · doi:10.3310/hsdr05120 · Cited by 51
Öhman, H., Savikko, N., Strandberg, T., Kautiainen, H., Raivio, M., Laakkonen, M.-L., Tilvis, R., & Pitkälä, K. H. (2016) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000445712 · Cited by 49
Smallfield, S., & Heckenlaible, C. (2017) · American Journal of Occupational Therapy · doi:10.5014/ajot.2017.024752 · Cited by 49
“Two studies were systematic reviews and thus contributed Level I evidence (Cooper et al., 2012; Olazarán et al., 2010), 3 were RCTs providing Level I evidence (Graessel et al., 2011; Luttenberger, Donath, Uter, & Graessel, 2012; Maci et al., 2012), 4 studies provided Level II evidence (Brooker,…”
BackgroundInfluentialAlzola, P., Pardo, C. C., Bermejo‐Pareja, F., Sánchez‐Benavides, G., Peña‐Casanova, J., Puertas‐Martín, V., Fernández‐Calvo, B., & Contador, I. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13123442 · Cited by 59
“In this context, psychosocial interventions that emphasize patients’ lifestyle factors and behaviors (e.g., physical exercise, relaxation, art therapy, sensory and behavioral interventions) are receiving more attention [234,235].”
BackgroundManagement of patients with Alzheimer’s disease: pharmacological treatment and quality of life
Mossello, E., & Ballini, E. (2012) · Therapeutic Advances in Chronic Disease · doi:10.1177/2040622312452387 · Cited by 51
Diagnosing Alzheimer's disease: A systematic review of economic evaluations
Handels, R. L. H., Wolfs, C. A. G., Aalten, P., Joore, M. A., Verhey, F. R. J., & Severens, J. L. (2013) · Alzheimer s & Dementia · doi:10.1016/j.jalz.2013.02.005 · Cited by 48
“Because current treatment guidelines do not advise medication in this disease phase and nonpharmacological treatments are mainly aimed at dementia-related symptoms [34], it leaves the diagnostic test impact mainly to nonmedical aspects [35], such as anxiety, depression, psychological well-being, (financial) decision-m…”
BackgroundGaugler, J. E., Potter, T., & Pruinelli, L. (2014) · Clinics in Geriatric Medicine · doi:10.1016/j.cger.2014.04.003 · Cited by 50
Lee, M., Ryoo, J. H., Chung, M., Anderson, J. G., Rose, K. M., & Williams, I. C. (2019) · Dementia · doi:10.1177/1471301218822640 · Cited by 48
In-Home Monitoring Support for Dementia Caregivers: A Feasibility Study
Williams, K., Arthur, A., Niedens, M., Moushey, L., & Hutfles, L. (2013) · Clinical Nursing Research · doi:10.1177/1054773812460545 · Cited by 47
“…support caregivers have had only minimal effects on reducing stress, burden, and the negative health effects of caregiving (National Familty Caregiver Association, 2011; Olazaran et al., 2010; Parker, Mills, & Abbey, 2008), now recognized as a growing public health problem (Talley & Crews, 2007).”
BackgroundFeasibility and efficacy of cognitive telerehabilitation in early Alzheimer’s disease: a pilot study
Cagnin, A., Jelcic, N., Agostini, M., Meneghello, F., Parise, S., Galano, A., Tonin, P., Dam, M., & Busse, C. (2014) · Clinical Interventions in Aging · doi:10.2147/cia.s68145 · Cited by 76
Brooker, D., Evans, S. C., Evans, S., Bray, J., Saibene, F. L., Scorolli, C., Szcześniak, D. M., d’Arma, A., Lion, K., Atkinson, T. J., et al. (2018) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.4865 · Cited by 46
Andrade, S. M., Machado, D. G. D. S., da Silva‐Sauer, L., Régis, C. T., Mendes, C. K. T. T., de Araújo, J. S. S., de Araújo, K. D. T., Costa, L. P., Queiroz, M. E. B. S., Leitão, M. M., et al. (2022) · Neurophysiologie Clinique · doi:10.1016/j.neucli.2022.02.003 · Cited by 46
Nanomedicine and drug delivery: A comprehensive review of applications and challenges
Singh, K., Singhal, S., Pahwa, S., Sethi, V. A., Sharma, S., Singh, P., Kale, R. D., Ali, S. W., & Sagadevan, S. (2024) · Nano-Structures & Nano-Objects · doi:10.1016/j.nanoso.2024.101403 · Cited by 50
Metadata
- Authors
- Olazarán, J., Reisberg, B., Clare, L., Cruz, I., Peña-Casanova, J., del Ser, T., Woods, B., Beck, C., Auer, S., Lai, C., Spector, A., Fazio, S., Bond, J., Kivipelto, M., Brodaty, H., Rojo, J. M., Collins, H., Teri, L., Mittelman, M., Orrell, M., Feldman, H. H., & Muñiz, R.
- Affiliations
- NYU Langone Health (US)
- Bangor University (GB)
- University of Arkansas for Medical Sciences (US)
- MAS Alzheimerhilfe (AT)
- Hong Kong Polytechnic University (HK)
- University College London (GB)
- Alzheimer's Association (US)
- Newcastle University (GB)
- Karolinska Institutet (SE)
- UNSW Sydney (AU)
- Consejo Superior de Investigaciones Científicas (ES)
- Cochrane (GB)
- University of Washington (US)
- University of British Columbia (CA)
- ORCID
- Venue
- Dementia and Geriatric Cognitive Disorders
- Publisher
- S. Karger AG
- Published
- 2010
- Volume
- 30
- Issue
- 2
- Pages
- 161-178
- ISSN
- 1420-8008 (ISSN-L)
- 1421-9824
- OpenAlex
- W2116861306
- Cited by
- 937
- References
- 229
- Citations by year
- 2026: 24 · 2025: 26 · 2024: 41 · 2023: 48 · 2022: 50 · 2021: 51 · 2020: 94 · 2019: 62 · 2018: 76 · 2017: 87 · 2016: 81 · 2015: 61 · 2014: 76 · 2013: 68 · 2012: 65
- FWCI
- 7.13
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Locations
- Dementia and Geriatric Cognitive Disorders (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- PolyU Institutional Research Archive (Hong Kong Polytechnic University) (submittedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Alzheimer's disease research and treatments
- Health Sciences › Medicine › Geriatrics and Gerontology › Geriatric Care and Nursing Homes
- Keywords
- Alzheimer's disease, non-pharmacological treatment, dementia, quality of life, caregivers, cognitive training, cognitive stimulation, multicomponent intervention, activities of daily living, mood, restraint prevention, caregiver education, treatment guidelines
- MeSH terms
- Activities of Daily Living, Aged, Complementary Therapies, Alzheimer Disease, Cost-Benefit Analysis, Humans, Institutionalization, Quality of Life, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Treatment Outcome, Caregivers, Disease Progression, Evidence-Based Medicine, Neurodegenerative Diseases, Learning Curve
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