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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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Cankurtaran, E. Ş. (2014) · Nöro Psikiyatri Arşivi · doi:10.5152/npa.2014.7405 · Cited by 20
“Another systematic review examining the non-pharmacological interventions identified a modest effect of behavior management therapies, education of the caregiver and the staf of nursing home, and also the cognitive stimulation techniques (25).”
BackgroundDebas, K., Beauchamp, J., & Ouellet, C. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.634398 · Cited by 15
Moody, E., McDougall, H., Weeks, L. E., Belliveau, A. C., Bilski, P., Macdonald, M., Williams, L., Khanna, I., Jamieson, H., Bradbury, K., et al. (2024) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2024.104838 · Cited by 15
Leavey, G., Abbott, A., Watson, M., Todd, S., COATES, V. E., McIlfactrick, S. J., McCormack, B. G., Waterhouse‐Bradley, B., & Curran, E. (2016) · BMC Health Services Research · doi:10.1186/s12913-016-1617-x · Cited by 15
“The evidence on interventions designed to support individuals with dementia and families who act as care partners is unclear [14, 15].”
BackgroundSexuality and Neurodegenerative Disease: An Unmet Challenge for Patients, Caregivers, and Treatment
Eshmawey, M. (2021) · Neurodegenerative Diseases · doi:10.1159/000522042 · Cited by 15
Buhagiar, K., Afzal, N., & Cosgrave, M. (2011) · Europe PMC (PubMed Central) · Cited by 15
Individualized guidelines for the management of aggression in dementia – Part 1: key concepts
Vickland, V., Chilko, N., Draper, B., Low, L., O’Connor, D., & Brodaty, H. (2012) · International Psychogeriatrics · doi:10.1017/s1041610212000014 · Cited by 15
“Interventions focusing on the individual’s situation and problem behavior are generally the most successful (Livingston et al., 2005), and Ballard et al. (2009) suggest that an intervention by a clinical psychologist may be valuable for severe symptoms.”
BackgroundBehavioral States of Children with Severe Disabilities in the Multisensory Environment
Tunson, J., & Candler, C. (2010) · Physical & Occupational Therapy In Pediatrics · doi:10.3109/01942630903546651 · Cited by 15
“Livingston et al. (2005) examined multiple psychological approaches for the management of psychiatric symptoms of dementia.”
BackgroundInfluence of Adherence to a Systematic Care Program for Caregivers of Dementia Patients
Spijker, A., Teerenstra, S., Wollersheim, H. C. H., Adang, E., Verhey, F. R. J., & Vernooij-Dassen, M. J. F. J. (2013) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2012.10.003 · Cited by 14
Gruppentherapeutische Behandlung bei beginnender dementieller Erkrankung
Scheurich, A., & Fellgiebel, A. (2009) · Zeitschrift für Neuropsychologie · doi:10.1024/1016-264x.20.1.21 · Cited by 14
Non-pharmacological treatments of challenging behaviours
James, I. A., Mackenzie, L. E., Pakrasi, S., & Fossey, J. (2008) · Nursing and Residential Care · doi:10.12968/nrec.2008.10.5.29141 · Cited by 14
Biphasic Insulin Aspart in Type??2??Diabetes Mellitus
Gough, S. C. L., & Tibaldi, J. M. (2007) · Clinical Drug Investigation · doi:10.2165/00044011-200727050-00002 · Cited by 14
Tampi, R. R., Tampi, D. J., & Balachandran, S. (2017) · Current Treatment Options in Psychiatry · doi:10.1007/s40501-017-0104-2 · Cited by 14
“Both non-pharmacological and pharmacological interventions have efficacy for the management of BPSD [9, 10].”
Backgroundden IJssel, J. C. L. V. D., Appelhof, B., Zwijsen, S. A., Smalbrugge, M., Verhey, F. R. J., de Vugt, M. E., Zuidema, S. U., Koopmans, R. T. C. M., & Bakker, C. (2017) · International Psychogeriatrics · doi:10.1017/s1041610217000941 · Cited by 14
“Other studies have shown that non-pharmacological interventions with less adverse effects are also effective in the management of NPS (Livingston et al., 2005; Cohen-Mansfield et al., 2007; Davison et al., 2007).”
BackgroundMedications in Long-Term Care: When Less is More
Meeks, T. W., Culberson, J. W., & Horton, M. S. (2011) · Clinics in Geriatric Medicine · doi:10.1016/j.cger.2011.01.003 · Cited by 17
Bakker, T. J. E. M., Duivenvoorden, H. J., van der Lee, J., Rikkert, M. G. M. O., Beekman, A. T. F., & Ribbe, M. W. (2012) · International Psychogeriatrics · doi:10.1017/s1041610212001305 · Cited by 13
“…that for individual psychiatric symptoms, e.g. depression and anxiety, as well as caregiver burden, psychotherapeutic treatment may be effective in both nursing home and primary care settings (Bakker et al., 2001; 2011; Scholey and Woods, 2003; Livingston et al., 2005; Davison et al., 2007).”
BackgroundResultClarkson, P., Challis, D., Hughes, J., Roe, B. H., Davies, L. M., Russell, I. T., Orrell, M. W., Poland, F. M., Jolley, D. J., Kapur, N., et al. (2021) · Programme Grants for Applied Research · doi:10.3310/pgfar09060 · Cited by 12
Relevance of Emotions and Beliefs in the Treatment of Behaviors that Challenge in Dementia Patients
James, I. A., & Hope, A. (2013) · Neurodegenerative Disease Management · doi:10.2217/nmt.13.60 · Cited by 13
Aggression, Agitation, Hyperactivity, and Irritability
Frederiksen, K. S., & Waldemar, G. (2016) · Neuropsychiatric symptoms of neurological disease · doi:10.1007/978-3-319-39138-0_9 · Cited by 13
Tampi, R. R., Tampi, D. J., Young, J. J., Hoq, R., & Resnick, K. (2019) · Neurodegenerative Disease Management · doi:10.2217/nmt-2019-0018 · Cited by 13
Neuropsychiatric symptoms as the main determinant of caregiver burden in Alzheimer's disease
Kochhann, R., Borba, E. M., Cerveira, M. O., Onyszko, D., de Jesus, A., Forster, L., Franciscatto, L., Godinho, C., Camozzato, A. L., & Chaves, M. L. F. (2011) · Dementia & Neuropsychologia · doi:10.1590/s1980-57642011dn05030008 · Cited by 13
“Specific types of caregiver and residential care staff education, behavior management therapies, and possibly cognitive stimulation, appear to offer long-term effectiveness for the management of dementia-associated neuropsychiatric symptoms.(29)”
BackgroundNon-pharmacological interventions for patients with dementia
Lee, G. E., Kim, J. Y., Jung, J.-H., Kang, H.-W., & Jung, I. C. (2019) · Medicine · doi:10.1097/md.0000000000017279 · Cited by 13
Evaluation of a transition care cognitive assessment and management pilot
Renehan, E., Haralambous, B., Galvin, P., Kotis, M., & Dow, B. (2013) · Contemporary Nurse · doi:10.5172/conu.2013.43.2.134 · Cited by 12
Clarke, C. L., Keyes, S., Wilkinson, H. A., Alexjuk, E. J., Wilcockson, J., Robinson, L. A., Reynolds, J., MCCLELLAND, S., Hodgson, P., Corner, L., et al. (2016) · Ageing and Society · doi:10.1017/s0144686x16001069 · Cited by 12
Smith, M., Schultz, S. K., Seydel, L. L., Reist, J. C., Kelly, M. C., Weckman, M., Gryzlak, B. M., & Carnahan, R. M. (2013) · Journal of Gerontological Nursing · doi:10.3928/00989134-20130314-04 · Cited by 13
Murray, L. L., & Paek, E. J. (2016) · Perspectives of the ASHA Special Interest Groups · doi:10.1044/persp1.sig15.12 · Cited by 12
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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