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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BackgroundEffects of Cognitive Training on Cognition and Quality of Life of Older Persons with Dementia
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BackgroundProcess evaluation of a social support platform ‘Inlife’ for caregivers of people with dementia
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“family care settings, where the most effective interventions were those that were tailored to both the person with dementia as well as their family carer (Olazaran et al., 2010).”
BackgroundThe Latest Advances in the Diagnosis and Treatment of Dementia
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“A systematic review of Olazarán and colleagues shows that NPS can be substantially diminished by behavioral interventions [12].”
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“Furthermore, CST demonstrates the best evidence for improving cognitive functioning among all psychosocial interventions.(10) In the first RCT,(11) significant improvements in both cognition and quality of life of CST compared with usual care (n=201) were documented.”
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“[7] The approved AD pharmacological interventions include ChEIs (donepezil, galantamine, rivastigmine) and N–methyl–”
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“Many of these interventions have been shown to be effective (Olazaran et al. , 2010; Dröes et al. , 2010b; Vernooij-Dassen et al. , 2010; Dröes et al. , 2011a).”
The role of cognitive activity in cognition protection: from Bedside to Bench
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“There are various approaches, including mental exercise, diet control and physical exercises [14, 15].”
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“As a result, non-pharmacological methods–using physical and non-chemical methods rather than medications, are becoming increasingly popular in the treatment for aged people with depression (17, 18).”
BackgroundHall, A., Burrows, L., Lang, I., Endacott, R., & Goodwin, V. A. (2018) · BMC Geriatrics · doi:10.1186/s12877-018-0756-9 · Cited by 32
Bruvik, F. K., Allore, H. G., Ranhoff, A. H., & Engedal, K. (2013) · Dementia and Geriatric Cognitive Disorders Extra · doi:10.1159/000355912 · Cited by 31
Boersma, P., van Weert, J. C. M., van Meijel, B., & Dröes, R. (2016) · Journal of Clinical Nursing · doi:10.1111/jocn.13432 · Cited by 31
Öhman, H., Savikko, N. M., Strandberg, T. E., Kautiainen, H., Raivio, M., Laakkonen, M., Tilvis, R. S., & Pitkälä, K. H. (2017) · European Geriatric Medicine · doi:10.1016/j.eurger.2017.01.004 · Cited by 32
“Still, high-quality randomized studies on nonpharmacological treatments strategies for NPS in AD are few [9].”
BackgroundCarer preferences for home support services in later stage dementia
Kampanellou, E., Chester, H., Davies, L. M., Davies, S., Giebel, C. M., Hughes, J., Challis, D., Clarkson, P., & Members of the HOST-D (Home Support in Dementia) Programme Management Group (2017) · Aging & Mental Health · doi:10.1080/13607863.2017.1394441 · Cited by 31
Wang, J., Wang, J., Liu, N., Liu, N., Mao, C., Dong, L., Li, J., Huang, X., Lei, D., Chu, S., et al. (2022) · Journal of Personalized Medicine · doi:10.3390/jpm12010037 · Cited by 31
“The diagnosis of MCI and dementia early has prognostic value [2,3].”
Förster, S., Buschert, V. C., Buchholz, H., Teipel, S. J., Friese, U., Zach, C., la Fougère, C., Rominger, A., Drzezga, A. E., Hampel, H. J., et al. (2011) · Journal of Alzheimer s Disease · doi:10.3233/jad-2011-100996 · Cited by 32
Prick, A.-E. J. C., de Lange, J., Leven, N. V., & Pot, A. M. (2014) · Trials · doi:10.1186/1745-6215-15-401 · Cited by 31
“Psychosocial interventions that address both the person with dementia and their caregiver (so-called dyadic or combined interventions) have the potential to reduce the frequency and severity of behavioral and psychological symptoms of dementia as well as negative caregiver reactions [7-12], especially when delivered i…”
BackgroundSprange, K., Mountain, G. A., Shortland, K., Craig, C., Blackburn, D. J., Bowie, P. C. W., Harkness, K., & Spencer, M. (2015) · Pilot and Feasibility Studies · doi:10.1186/s40814-015-0039-6 · Cited by 31
“Evidence suggests that psychosocial interventions can play a significant role in supporting people post diagnosis [6] and in particular interventions that involve the person with the diagnosis and their caregiver with the aim of improving the quality of life of both [7].”
Prick, A.-E. J. C., de Lange, J., Scherder, E., Twisk, J. W. R., & Pot, A. M. (2017) · Journal of Aging and Physical Activity · doi:10.1123/japa.2016-0038 · Cited by 34
Vandepitte, S., Putman, K. D., Noortgate, N. V. D., Verhaeghe, S. T. L., Mormont, E., Wilder, L. V., Smedt, D. D., & Annemans, L. (2018) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000494023 · Cited by 31
Forstmeier, S., Maercker, A. R. A., Savaskan, E., & Roth, T. (2015) · Trials · doi:10.1186/s13063-015-1043-0 · Cited by 31
“A whole variety of different approaches can be described as psychosocial (or non-pharmacological) interventions for dementia patients [9].”
Backgroundvan Knippenberg, R. J. M., de Vugt, M. E., Ponds, R., Myin‐Germeys, I., & Verhey, F. R. J. (2018) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2018.06.004 · Cited by 30
Döpp, C. M. E., Graff, M. J. L., Teerenstra, S., Rikkert, M. G. M. O., der Sanden, M. W. G. N., & Vernooij-Dassen, M. J. F. J. (2014) · Clinical Rehabilitation · doi:10.1177/0269215514564699 · Cited by 30
Spector, A. E., Orrell, M. W., Lattimer, M., Hoe, J., King, M., Harwood, K. E., Qazi, A., & Charlesworth, G. M. (2012) · Trials · doi:10.1186/1745-6215-13-197 · Cited by 30
“There are limits in the effectiveness and use of dementia medication [2] and in recent years there has been an increase in the development of psychosocial treatments for dementia [3].”
Interventions for caregivers of patients with dementia.
Martı́n-Carrasco, M., Ballesteros-Rodríguez, J., Domínguez-Panchón, A. I., Muñoz-Hermoso, P., & González–Fraile, E. (2014) · PubMed · Cited by 30
Dethlefs, N., Milders, M. M., Cuayáhuitl, H., Al-Salkini, T., & Douglas, L. (2017) · Informatics for Health and Social Care · doi:10.1080/17538157.2016.1255627 · Cited by 30
“However, reminiscence presented by a person in small groups has shown to be effective for improving cognition and daily functioning in people with dementia [3].”
BackgroundChapter 19. Incarceration Reform
Joy, M. T. (2020) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9780873182591.lg19 · Cited by 29
Reducing Physical Restraints in Nursing Homes: A Report From Maria Wolff and Sanitas
Múñiz, R., GÓmez, S. T., Curto, D., Hernández, R., Marco, B., García, P. P., Tomás, J. F., & Olazarán, J. (2016) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2016.03.011 · Cited by 29
Briones-Peralta, M. Á., García, I. P., & Sotos, F. E. (2019) · Clinical Nursing Research · doi:10.1177/1054773819867250 · Cited by 43
“Moreover, these nonpharmacological therapies have now been established as a useful, versatile, and potentially cost-effective tool to mitigate the clinical manifestations of the disease and enhance the quality of life of both dementia patients and their caregivers (Olazarán et al., 2010).”
BackgroundSteinbeißer, K., Schwarzkopf, L., Graessel, E., & Seidl, H. (2020) · The European Journal of Health Economics · doi:10.1007/s10198-020-01175-y · Cited by 29
Sommerlad, A., Manela, M., Cooper, C., Rapaport, P., & Livingston, G. (2014) · BMJ Open · doi:10.1136/bmjopen-2014-005273 · Cited by 29
Tanaka, S., Honda, S., Nakano, H., Sato, Y., Araya, K., & Yamaguchi, H. (2016) · Psychogeriatrics · doi:10.1111/psyg.12212 · Cited by 29
Söylemez, B., Küçükgüçlü, Ö., & Buckwalter, K. (2016) · Journal of Gerontological Nursing · doi:10.3928/00989134-20160406-01 · Cited by 22
Sepe‐Monti, M., Caregiver Study Group Savvy, Vanacore, N., Bartorelli, L., Tognetti, A., & Giubilei, F. (2016) · Journal of Alzheimer s Disease · doi:10.3233/jad-160235 · Cited by 30
Akushevich, I. V., Yashkin, A. P., Kravchenko, J. S., Ukraintseva, S. V., Stallard, E., & Yashin, A. I. (2018) · Journal of Alzheimer s Disease · doi:10.3233/jad-180060 · Cited by 28
da Silva, R. C. G., Abrunheiro, S. F. S., Cardoso, D., Santos‐Costa, P., Couto, F. C., Agrenha, C., & Apóstolo, J. (2018) · The JBI Database of Systematic Reviews and Implementation Reports · doi:10.11124/jbisrir-2017-003483 · Cited by 28
“Unauthorize cognitive decline from a previous level of performance in one or more of the cognitive domains outlined above.1,2 Therefore, it is characterized by a progressive deterioration in cognitive ability and capacity for independent living.1,3 Neuropsychiatric symptoms (NPS) affect older adults with major NCD acr…”
BackgroundInfluentialVreese, L. P. D., Mantesso, U., Bastiani, E. D., Weger, E., Marangoni, A., & Gomiero, T. (2012) · Journal of Policy and Practice in Intellectual Disabilities · doi:10.1111/j.1741-1130.2012.00344.x · Cited by 28
Aguirre, E., Hoare, Z., Spector, A. E., Woods, B. T., & Orrell, M. W. (2014) · BMC Geriatrics · doi:10.1186/1471-2318-14-31 · Cited by 36
“Systematic reviews have found cognitive stimulation to be a psychosocial intervention for people with dementia [1,8-10], which has robust evidence.”
BackgroundGitlin, L. N., Hodgson, N. A., & Choi, S. (2015) · Springer eBooks · doi:10.1007/978-3-319-18377-0_11 · Cited by 28
Orrell, M. W., Hoe, J., Charlesworth, G. M., Russell, I. T., Challis, D., Moniz-Cook, E. D., Knapp, M. R. J., Woods, B. T., Hoare, Z., Aguirre, E., et al. (2017) · Programme Grants for Applied Research · doi:10.3310/pgfar05050 · Cited by 28
“Hazards related to daily living tasks 172 (76)(1) 264 (67)(3) 44 (61)(5) 18 (72)(2) 498 (69)(2) 0.”
Zafra, M. D. O., Hernández-García, L., Gonzalez-del-Valle, M. T., Parra-Fernández, M. L., & Martínez, E. F. (2017) · Holistic Nursing Practice · doi:10.1097/hnp.0000000000000247 · Cited by 28
Özbe, D., Graessel, E., Donath, C., & Pendergrass, A. (2019) · Journal of Alzheimer s Disease · doi:10.3233/jad-180980 · Cited by 28
“[9] could have overestimated the effects of multicomponent interventions, because the included studies were too different.”
BackgroundMethodInfluentialChristie, H. L., Dam, A. E. H., van Boxtel, M. P. J., Köhler, S., Verhey, F. R. J., & de Vugt, M. E. (2022) · JMIR Aging · doi:10.2196/38656 · Cited by 27
“However, the effects are generally small to moderate, and available studies are limited in their methodological quality [14].”
Søgaard, R., Sørensen, J. R., Waldorff, F. B., Eckermann, A., Buss, D. V., Phung, T. K. T., & Waldemar, G. (2014) · BMJ Open · doi:10.1136/bmjopen-2013-004105 · Cited by 27
“However, the authors of a systematic literature review concluded that non-pharmacological strategies are useful, versatile and potentially cost-effective approaches to improve outcomes.(4) One such approach was developed as part of the Danish Alzheimer’s Intervention Study (DAISY) in 2004.”
BackgroundDavies, A. K., Brini, S., Hirani, S. P., Gathercole, R. L., Forsyth, K., Henderson, C., Bradley, R., Davies, L. C., Dunk, B., Harper, E., et al. (2020) · Alzheimer s & Dementia Translational Research & Clinical Interventions · doi:10.1002/trc2.12064 · Cited by 27
Clarkson, P., Giebel, C. M., Larbey, M., Roe, B. H., Challis, D., Hughes, J., Jolley, D. J., Poland, F. M., Russell, I. T., & Members of the HoSt‐D (Home Support in Dementia) Programme Management Group (2015) · Journal of Advanced Nursing · doi:10.1111/jan.12737 · Cited by 26
Outcomes of Person-centered Care for Persons with Dementia in the Acute Care Setting: A Pilot Study
Chenoweth, L., Williams, A., Fry, M., Endean, E., & Liu, Z. (2021) · Clinical Gerontologist · doi:10.1080/07317115.2021.1946233 · Cited by 26
“Systematic reviews and meta-analyses of the Kitwood (1997) PCC model in community and long-term care settings have confirmed that when PCC is supported at the system-level it is applicable and cost-effective in improving clinical and psychosocial outcomes in persons with dementia (Chenoweth et al., 2019; Kim & Park, 2…”
Background
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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