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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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“Those which have addressed psychosocial interventions for people with dementia, have focused on the agenda to ameliorate symptoms [25–27], reduce challenging behaviours, (including agitation and wandering) [12, 28–32]; enable a reduction of medication [33], improve cognitive function [34, 35], or a combination of all…”
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“found in their review that staff education and psychological and psychosocial treatments were effective [11].”
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“This is particularly important given that several previous studies have indicated that positive outcomes were not maintained over extended periods of time (see review in Livingston et al., 2005).”
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“There is a wide variety of proposed non-pharmacologic treatments and while understanding that response to interventions is unpredictable, a meta-analysis of various psychological approaches found that behavior management therapies and specific types of caregiver and residential care staff education had the most lastin…”
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“Other nonpharmacological approaches such as reminiscence therapy, validation therapy, reorientation techniques, music therapy, Snoezelen, and interventions with carers have also been investigated, but evidence for efficacy is equivocal [17].”
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“However, caregivers with higher burden were caring for patients with higher levels of anxiety; t(49) 1⁄4 –2.”
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“evidence of long-term benefits (Livingston et al., 2005) and for the weaknesses in study designs (McDermott et al.”
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“…format, the benefits of the individualized approach are well substantiated in the caregiving intervention literature (see meta-analyses: Knight, Lutzky, & Makofsky-Urban, 1993; Livingston et al., 2005 and Clark, Chaston, & Grant, 2003; Gerdner, Buckwalter, & Reed, 2002; Yin, Zhou & Bashford, 2002).”
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Caregivers’ experience of risk in dementia: The LASER-AD Study
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“There is a burgeoning literature on caregiver interventions to address neuropsychiatric symptoms of dementia (Livingston, Johnston, Katona, Paton, & Lyketsos, 2005 ) and behavioural management strategies appear to be very helpful.”
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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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