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Systematic Review of Psychological Approaches to the Management of Neuropsychiatric Symptoms of Dementia
Open accessAbstract
OBJECTIVE: The authors systematically reviewed the literature on psychological approaches to treating the neuropsychiatric symptoms of dementia. METHOD: Reports of studies that examined effects of any therapy derived from a psychological approach that satisfied prespecified criteria were reviewed. Data were extracted, the quality of each study was rated, and an overall rating was given to each study by using the Oxford Centre for Evidence-Based Medicine criteria. RESULTS: A total of 1,632 studies were identified, and 162 satisfied the inclusion criteria for the review. Specific types of psychoeducation for caregivers about managing neuropsychiatric symptoms were effective treatments whose benefits lasted for months, but other caregiver interventions were not. Behavioral management techniques that are centered on individual patients' behavior or on caregiver behavior had similar benefits, as did cognitive stimulation. Music therapy and Snoezelen, and possibly sensory stimulation, were useful during the treatment session but had no longer-term effects; interventions that changed the visual environment looked promising, but more research is needed. CONCLUSIONS: Only behavior management therapies, specific types of caregiver and residential care staff education, and possibly cognitive stimulation appear to have lasting effectiveness for the management of dementia-associated neuropsychiatric symptoms. Lack of evidence regarding other therapies is not evidence of lack of efficacy. Conclusions are limited because of the paucity of high-quality research (only nine level-1 studies were identified). More high-quality investigation is needed.
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“According to Livingston et al. [45], agitation in dementia is associated with poorer quality of life and impairs the engagement in daily activities and relationships.”
From Nonpharmacological Interventions to Reduce Behavioral and Psychological Symptoms of Dementia: A Systematic Review (2015) · cites this paper as [45]
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Self-citationSubjective needs of people with dementia: a review of the literature
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“Therefore, increased attention has been paid to nonpharmacological interventions which are associated with fewer risks (Livingston, Johnston, Katona, Paton, & Lyketsos, 2005 ).”
BackgroundDancing as a psychosocial intervention in care homes: a systematic review of the literature
Guzmán, A., Hughes, J. C., James, I. A., & Rochester, L. (2012) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.3913 · Cited by 131
“We have identified that a broad range of activity based interventions are emerging (Livingston et al., 2005; James and Fossey, 2008).”
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Seitz, D. P., Adunuri, N., Gill, S. S., Gruneir, A., Herrmann, N., & Rochon, P. (2011) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd008191.pub2 · Cited by 304
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“Behavior therapy using antecedentbehavior-consequence (ABC) diary assessment has provided good sustained improvements in behavior [106,107].”
BackgroundMethodSelf-citationChoi, A., Lee, M. S., & Lim, H. (2008) · The Journal of Alternative and Complementary Medicine · doi:10.1089/acm.2008.0006 · Cited by 128
Psychosocial interventions for dementia patients in long-term care
Vernooij-Dassen, M. J. F. J., Vasse, E., Zuidema, S. U., Cohen‐Mansfield, J., & Moyle, W. (2010) · International Psychogeriatrics · doi:10.1017/s1041610210001365 · Cited by 127
“, 2003) and the positive effects of cognitive stimulation (Livingston et al., 2005).”
InfluentialMultisensory Stimulation for People With Dementia
Sánchez, A., Millán-Calentí, J. C., Lorenzo‐López, L., & Maseda, A. (2012) · American Journal of Alzheimer s Disease & Other Dementias® · doi:10.1177/1533317512466693 · Cited by 127
de Medeiros, K., & Basting, A. D. (2013) · The Gerontologist · doi:10.1093/geront/gnt055 · Cited by 141
O'Connor, D. W., Ames, D., Gardner, B., & King, M. (2009) · International Psychogeriatrics · doi:10.1017/s1041610208008223 · Cited by 126
Robinson, L. A., Iliffe, S., Brayne, C., Goodman, C. M., Rait, G., Manthorpe, J., Ashley, P., & Moniz-Cook, E. D. (2009) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.2405 · Cited by 126
Evidence-Based Interventions to Improve Quality of Life for Individuals with Dementia.
Logsdon, R. G., McCurry, S. M., & Teri, L. L. (2007) · PubMed · Cited by 126
Orgeta, V., Leung, P., Yates, L., Kang, S., Hoare, Z., Henderson, C., Whitaker, C. J., Burns, A. S., Knapp, M. R. J., Leroi, I., et al. (2015) · Health Technology Assessment · doi:10.3310/hta19640 · Cited by 136
“Reason Total, n (%) Does not wish to take part 320 (24) iCST exclusion criteria apply 295 (22) Dyad has not responded 215 (16) Could not make contact/reason not known 53 (4) Not available owing to holiday/family/work commitments 33 (2) Health problems for dyad 21 (2) Subtotals 937 (70) Other Prefers group activities/d…”
MethodInfluentialMaidment, I., Fox, C., Boustani, M. A., Menés, J. R., Brown, R. C., & Katona, C. (2007) · Annals of Pharmacotherapy · doi:10.1345/aph.1k372 · Cited by 121
Self-citationHulme, C. T., Wright, J. M., Crocker, T. F., Oluboyede, Y., & House, A. O. (2009) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.2429 · Cited by 118
“The final review (Livingston et al., 2005) reported on 25 papers but judged them of low quality.”
BackgroundInfluentialBallard, C. G., Corbett, A., Chitramohan, R., & Aarsland, D. (2009) · Current Opinion in Psychiatry · doi:10.1097/yco.0b013e32833111f9 · Cited by 116
Zwijsen, S. A., Smalbrugge, M., Eefsting, J. A., Twisk, J. W. R., Gerritsen, D. L., Pot, A. M., & Hertogh, C. M. P. M. (2014) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2014.04.007 · Cited by 114
Frontotemporal Dementias: A Review
Weder, N. D., Aziz, R., Wilkins, K. M., & Tampi, R. R. (2007) · Annals of General Psychiatry · doi:10.1186/1744-859x-6-15 · Cited by 119
Satoh, M., Yuba, T., Tabei, K., Okubo, Y., Kida, H., Sakuma, H., & Tomimoto, H. (2015) · Dementia and Geriatric Cognitive Disorders Extra · doi:10.1159/000436960 · Cited by 108
Waldorff, F. B., Buss, D. V., Eckermann, A., Rasmussen, M. L. H., Keiding, N., Rishoj, S., Siersma, V., Sorensen, J., Sorensen, L. V., Vogel, A., et al. (2012) · BMJ · doi:10.1136/bmj.e4693 · Cited by 106
Choi, A., Lee, M. S., Cheong, K.-J., & Lee, J. (2009) · International Journal of Neuroscience · doi:10.1080/00207450802328136 · Cited by 106
Azcurra, D. S. (2012) · Brazilian Journal of Psychiatry · doi:10.1016/j.rbp.2012.05.008 · Cited by 114
Depression in Alzheimer's disease: Phenomenology, clinical correlates and treatment
STARKSTEIN, S. E., Mizrahi, R., & Power, B. (2008) · International Review of Psychiatry · doi:10.1080/09540260802094480 · Cited by 107
White, N., Leurent, B., Lord, K., Scott, S., Jones, L., & Sampson, E. L. (2017) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.4463 · Cited by 103
“Patients who were prescribed antipsychotics, after adjusting for end of life medication, age and dementia severity, were significantly more likely to die (adjusted hazard ratio 5.78, 95% CI 1.57, 21.26, p=0.008).”
BackgroundInfluentialNon‐pharmacological management of behavioural symptoms in nursing homes
Deudon, A., Maubourguet, N., Gervais, X., Leone, E., Brocker, P., Carcaillon, L., Riff, S., Lavallart, B., & Robert, P. H. (2009) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.2275 · Cited by 102
“Livingston et al. (2005) identified a total of 1632 studies and only 162 satisfied the inclusion criteria for the review.”
BackgroundDiagnosing and Treating Depression in Patients with Alzheimer’s Disease
Burke, A. D., Goldfarb, D., Bollam, P., & Khokher, S. (2019) · Neurology and Therapy · doi:10.1007/s40120-019-00148-5 · Cited by 115
A model for streamlining psychotherapy in the RDoC era: the example of ‘Engage’
Alexopoulos, G. S., & Arean, P. (2014) · Molecular Psychiatry · doi:10.1038/mp.2013.150 · Cited by 95
Effects of Person-Centered Care Approaches to Dementia Care on Staff
Barbosa, A., de Sousa, L. X. M., Nolan, M., & de Figueiredo, D. M. P. (2014) · American Journal of Alzheimer s Disease & Other Dementias® · doi:10.1177/1533317513520213 · Cited by 112
Ihl, R., Frölich, L., Winblad, B. G., Schneider, L. S. S., Burns, A. S., Möller, H., & WFSBP Task Force on Treatment Guidelines for Alzheimer's Disease and other Dementias (2011) · The World Journal of Biological Psychiatry · doi:10.3109/15622975.2010.538083 · Cited by 99
“Nevertheless, several studies investigated these aspects (see Livingston et al. 2005; O ’ Connor et al. 2009a,b; Gauthier et al. 2010, for reviews).”
BackgroundO'Neil, M. E., Freeman, M., Christensen, V., Telerant, R., Addleman, A., & Kansagara, D. L. (2011) · Cited by 96
Kiosses, D. N., Leon, A. C., & Areán, P. A. (2011) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2011.03.001 · Cited by 91
Kiosses, D. N., Areán, P. A., Teri, L. L., & Alexopoulos, G. S. (2010) · American Journal of Geriatric Psychiatry · doi:10.1097/jgp.0b013e3181d6947d · Cited by 94
Rosen, T., Lachs, M. S., & Pillemer, K. A. (2010) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2010.03064.x · Cited by 92
Lyketsos, C. G. (2007) · International Psychogeriatrics · doi:10.1017/s104161020700484x · Cited by 92
“Consequently, NPS are a significant focus of treatment with a wide range of treatments having been investigated, both pharmacological (Sink et al., 2005; Weintraub and Katz, 2005) and non-pharmacological (Livingston et al., 2005).”
BackgroundInfluentialSelf-citationTampi, R. R., & Tampi, D. J. (2014) · American Journal of Alzheimer s Disease & Other Dementias® · doi:10.1177/1533317514524813 · Cited by 92
Impact of Adult Day Services on Behavioral and Psychological Symptoms of Dementia
Femia, E. E., Zarit, S. H., Stephens, M. A. P., & Greene, R. (2007) · The Gerontologist · doi:10.1093/geront/47.6.775 · Cited by 90
Brief Psychosocial Therapy for the Treatment of Agitation in Alzheimer Disease (The CALM-AD Trial)
Ballard, C. G., Brown, R. G., Fossey, J., Douglas, S., Bradley, P., Hancock, J., James, I. A., Juszczak, E., Bentham, P., Burns, A. S., et al. (2009) · American Journal of Geriatric Psychiatry · doi:10.1097/jgp.0b013e3181b0f8c0 · Cited by 86
“Other studies of nonpharmacologic interventions have been encouraging(19) but are generally small scale and underpowered.(20) The two most substantial trials so far undertaken have focused on either generic agitation(21) or the specific agitation symptom of abnormal vocalizations,(22) demonstrating significant benefit…”
Management of mild to moderate Alzheimer's disease and dementia
Hogan, D. B., Bailey, P., Carswell, A., Clarke, B., Cohen, C. A., Forbes, D. A., Man‐Son‐Hing, M., Lanctôt, K. L., Morgan, D., & Thorpe, L. (2007) · Alzheimer s & Dementia · doi:10.1016/j.jalz.2007.07.006 · Cited by 85
Personalized dementia care: proven effectiveness of psychosocial interventions in subgroups.
van Mierlo, L. V., der Roest, H. G. V., Meiland, F., & Dröes, R. (2010) · Ageing Research Reviews · doi:10.1016/j.arr.2009.09.002 · Cited by 77
“Many reviews in the past (e.g. Eggermont and Scherder, 2006; Livingston et al., 2005; Smits et al., 2007) have tried to give an overview of effective psychosocial interventions, but failed to systematically provide information concerning characteristics of the subgroups for which those…”
BackgroundKurz, A. F., Leucht, S., & Lautenschlager, N. T. (2011) · International Psychogeriatrics · doi:10.1017/s1041610211001001 · Cited by 82
“Within the variety of interventions that have been developed (Livingston et al., 2005; Forbes et al., 2008; Blankevoort et al., 2010; Olazarán et al., 2010) cognitionfocused approaches aim at restoring memory and other cognitive abilities or at compensating impairments in order to preserve functioning in the everyday…”
BackgroundTestad, I., Ballard, C. G., Brønnick, K., & Aarsland, D. (2010) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.09m05486oli · Cited by 86
Mental health care for the elderly in low-income countries: a health systems approach.
Prince, M. J., Livingston, G., & Katona, C. (2007) · PubMed Central · Cited by 81
Self-citation
Metadata
- Authors
- Livingston, G., Johnston, K., Katona, C., Paton, J., Lyketsos, C. G., & Old Age Task Force of the World Federation of Biological Psychiatry
- Affiliations
- University College London (GB)
- Corresponding author
- Livingston, Gill
- Venue
- American Journal of Psychiatry
- Published
- 2005-11-01
- Volume
- 162
- Issue
- 11
- Pages
- 1996-2021
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- OpenAlex
- W2150798548
- Cited by
- 591
- References
- 172
- Citations by year
- 2026: 6 · 2025: 8 · 2024: 14 · 2023: 8 · 2022: 17 · 2021: 16 · 2020: 10 · 2019: 28 · 2018: 21 · 2017: 39 · 2016: 38 · 2015: 28 · 2014: 46 · 2013: 47 · 2012: 56
- FWCI
- 3.50
- Type
- journal article
- Language
- en
- Open access
- green
- discovery.ucl.ac.uk
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Kent Academic Repository (University of Kent) (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Geriatrics and Gerontology › Geriatric Care and Nursing Homes
- Social Sciences › Psychology › Clinical Psychology › Art Therapy and Mental Health
- Keywords
- psychological intervention, caregiver interventions, cognitive stimulation therapy, music therapy, Snoezelen, sensory stimulation, long-term treatment effectiveness
- MeSH terms
- Behavior Therapy, Dementia, Humans, Person-Centered Psychotherapy, Patient Education as Topic, Psychotherapy, Research Design, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Treatment Outcome, Caregivers, Guidelines as Topic, Evidence-Based Medicine
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