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Cited by 297Dementia and Cognitive Impairment ResearchAlzheimer's disease research and treatmentsCognitive Functions and Memory

The Multidisciplinary Approach to Alzheimer’s Disease and Dementia. A Narrative Review of Non-Pharmacological Treatment

Open access
Zucchella, Chiara, Sinforiani, Elena, Tamburin, Stefano, Federico, Angela, Mantovani, Elisa, Bernini, Sara, Casale, Roberto, Bartolo, Michelangelo·2018·Frontiers in Neurology
DOI 10.3389/fneur.2018.01058PMC PMC6300511
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Abstract

Background. Alzheimer’s disease (AD) and dementia are chronic diseases with progressive deterioration of cognition, function and behavior leading to severe disability and death. The prevalence of AD and dementia is constantly increasing because of the progressive aging of the population. These conditions represent a considerable challenge to patients, their family and caregivers, and the health system, because of the considerable need for resources allocation. There is no disease modifying intervention for AD and dementia, and the symptomatic pharmacological treatments has limited efficacy and considerable side effects. Non-pharmacological treatment (NPT), which includes a wide range of approaches and techniques, may play a role in the treatment of AD and dementia. Aim. To review, with a narrative approach, current evidence on main NPTs for AD and dementia. Methods. PubMed and the Cochrane database of systematic reviews were searched for studies written in English and published from 2000 to 2018. The bibliography of the main articles was checked to detect other relevant papers. Results. The role of NPT has been largely explored in AD and dementia. The main NPT types, which were reviewed here, include exercise and motor rehabilitation, cognitive rehabilitation, NPT for behavioral and psychological symptoms of dementia, occupational therapy, psychological therapy, complementary and alternative medicine, and new technologies, including information and communication technologies, assistive technology and domotics, virtual reality, gaming and telemedicine. We also summarized the role of NPT to address caregivers’ burden. Conclusions. Although NPT is often applied in the multidisciplinary approach to AD and dementia, supporting evidence for their use is still preliminary. Some studies showed statistically significant effect of NPT on some outcomes, but their clinical significance is uncertain. Well-designed randomized controlled trials with innovative designs are needed to explore the efficacy of NPT in AD and dementia. Further studies are required to offer robust neurobiological grounds for the effect of NPT, and to examine its cost-efficacy profile in patients with dementia.

AI snapshot

Written from the paper’s full text.

TL;DR

This narrative review summarizes non-pharmacological treatments (NPT) for Alzheimer’s disease and dementia, covering exercise, cognitive intervention, BPSD management, occupational therapy, psychological therapy, multicomponent strategies, complementary and alternative medicine, and new technologies. It concludes that NPT is widely used in multidisciplinary care, but supporting evidence remains preliminary, with uncertain clinical significance and a need for better-designed randomized controlled trials.

Key findings

  • The review reports that worldwide approximately 40 million people over 65 years suffer from dementia, and 70% of them are affected by Alzheimer’s disease; in the European Union, dementia cases were forecast to exceed 15 million in 2020.
  • Evidence levels vary by treatment: exercise/motor rehabilitation, cognitive stimulation (CS), and Cognitive Stimulation Therapy (CST) are rated “Moderate”; cognitive training (CT), occupational therapy, psychological therapy, multicomponent/multidimensional strategies, and music therapy are rated “Small”; aromatherapy, art therapy, and massage/touch are rated “Very small.”
  • BPSD are highly prevalent: 50–80% in AD, >80% in fronto-temporal dementia, and 50–70% in Lewy body dementia and vascular dementia; apathy prevalence in AD ranges from 19 to 88%.
  • Some specific findings include: a Cochrane review of 17 RCTs confirmed exercise reduced progression of dependence in ADL but showed limited evidence for cognition, BPSD, QoL, depression, mortality, caregiver burden, and healthcare use; a psychological intervention review included six RCTs (n=216 psychological treatment vs n=223 usual care/placebo) and found reduced depression and clinician-rated anxiety but no effect on ADL, QoL, BPSD, cognition, or caregiver depressive symptoms; a massage/touch meta-analysis of 11 RCTs found significant effects on some behaviors but low study quality prevented firm conclusions.

Methods

  • Narrative review; PubMed and the Cochrane Database of Systematic Reviews were searched for English-language studies published from 2000 to 2018, with bibliography checking of main articles to detect additional relevant papers.
  • The review focused on main NPT strategies for AD and dementia and did not include NPT in mild cognitive impairment (MCI).
  • Because of heterogeneity in interventions and outcome measures, the authors explicitly chose a narrative rather than systematic design to provide a clinician-oriented state-of-the-art overview.

Limitations

  • The paper states the main limitation is its narrative design, which was chosen because a systematic review was not feasible given the large number of studies; it also states that only two search engines were used (PubMed and Cochrane), and that other databases such as Embase, PsycINFO, and Web of Science would have yielded more literature.
  • The paper states that studies on NPT commonly have small numbers of high-quality or double-blind RCTs, small sample sizes, heterogeneity in design/intervention/outcomes, and uncertainty about the clinical significance of outcomes.
  • The text makes evident additional limitations: safety of NPT for BPSD is largely unexplored, cost-effectiveness data are lacking for several interventions, and many CAM and technology studies are preliminary or methodologically weak.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.3389/fneur.2018.01058

Cites

377 of 377 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 420 cited sources checked · 0 supported · 0 flagged

  • Premisecitation

    Exercise improves physical health and well-being in patients with AD or dementia.

    “Exercise has been documented to improve physical health and well-being (33), to reduce behavioral and psychological symptoms of dementia (BPSD) (34–36), and to enhance performance in the activities of daily living (ADL) (37, 38) in patients with AD or dementia.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [33] Teri, 2008, Exercise interventions for dementia and cognitive impairment: the Seattle protocols, J Nutr Health Aging source

      Not checked in the free run.

  • Premisecitation

    Moderate intensity midlife physical activity is significantly associated with a decreased risk of incident dementia in patients with mild cognitive impairment.

    “A recent paper derived from the population-based Mayo Clinic study of aging on 280 MCI patients showed that moderate intensity midlife physical activity was significantly associated with a decreased risk of incident dementia (25).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [25] Krell-Roesch, 2018, Leisure-time physical activity and the risk of incident dementia: the mayo clinic study of aging, J Alzheimers Dis. source

      Not checked in the free run.

  • Premisecitation

    Exercise reduces behavioral and psychological symptoms of dementia in patients with AD or dementia.

    “Exercise has been documented to improve physical health and well-being (33), to reduce behavioral and psychological symptoms of dementia (BPSD) (34–36), and to enhance performance in the activities of daily living (ADL) (37, 38) in patients with AD or dementia.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [34] Scherder, 2010, The more physical inactivity, the more agitation in dementia, Int Psychogeriatr. source

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    • cites [35] Thune-Boyle, 2012, The effect of exercise on behavioural and psychological symptoms of dementia: towards a research agenda, Int Psychogeriatr. source

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    • cites [36] Fleiner, 2017, Structured physical exercise improves neuropsychiatric symptoms in acute dementia care: a hospital-based RCT, Alzheimers Res Ther. source

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  • Interpretationcitation

    Evidence on the protecting role of short-term, single-component physical activity interventions is largely insufficient.

    “Conversely, the evidence on the protecting role of short-term, single-component physical activity interventions seems to be largely insufficient (32).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [32] Brasure, 2018, Physical activity interventions in preventing cognitive decline and alzheimer-type dementia: a systematic review, Ann Intern Med. source

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  • Premisecitation

    Exercise enhances performance in activities of daily living in patients with AD or dementia.

    “Exercise has been documented to improve physical health and well-being (33), to reduce behavioral and psychological symptoms of dementia (BPSD) (34–36), and to enhance performance in the activities of daily living (ADL) (37, 38) in patients with AD or dementia.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [37] Kwak, 2008, Effect of regular exercise on senile dementia patients, Int J Sports Med. source

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    • cites [38] Vidoni, Aerobic exercise sustains performance of instrumental activities of daily living in early-stage Alzheimer disease, J Geriatr Phys Ther. source

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  • May combine two claims. 88
  • Classified as probably not a substantial claim. 18
  • The quote only partly states this claim. 1

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    Premisecitation

    Cholinesterase inhibitors and memantine may improve cognitive and behavioral outcomes in AD, but their clinical impact remains modest and controversial.

    “Cholinesterase inhibitors and memantine, which are the only commercially available symptomatic drugs, may improve cognitive and behavioral outcomes, but their clinical impact remains modest and controversial (5–7).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [5] Birks, 2006, Cholinesterase inhibitors for Alzheimer's disease, Cochrane Database Syst Rev. source

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    • cites [6] Birks, 2015, Rivastigmine for Alzheimer's disease, Cochrane Database Syst Rev. source

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    • cites [7] Wong, 2016, Pharmacotherapy for dementia: a practical approach to the use of cholinesterase inhibitors and memantine, Drugs Aging source

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  • May combine two claims.

    Premisecitation

    Regular physical activity may enhance cognitive function and reduce the risk of AD and other dementias and delay their onset or progression.

    “A number of prospective cohort studies suggested that a regular physical activity may enhance cognitive function and reduce the risk of AD and other dementias and delay their onset or progression (16–24).”
    Quote in the paperSubstantial claim0 of 9 sources checked
    • cites [16] Lautenschlager, 2010, Physical activity and mild cognitive impairment and Alzheimer's disease, Curr Neurol Neurosci Rep. source

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    • cites [17] Yaffe, 2001, A prospective study of physical activity and cognitive decline in elderly women: women who walk, Arch Intern Med. source

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    • cites [18] Podewils, 2005, Physical activity, APOE genotype, and dementia risk: findings from the cardiovascular health cognition study, Am J Epidemiol. source

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    • cites [19] Barnes, 2008, Cognition in older women: the importance of daytime movement, J Am Geriatr Soc. source

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    • cites [20] Middleton, 2008, Changes in cognition and mortality in relation to exercise in late life: a population based study, PLoS ONE source

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    • cites [21] Brown, 2013, Multiple effects of physical activity on molecular and cognitive signs of brain aging: can exercise slow neurodegeneration and delay Alzheimer's disease?, Mol Psychiatry source

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    • cites [22] Hamer, 2018, Physical activity and trajectories in cognitive function: English longitudinal study of ageing, J Epidemiol Community Health source

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    • cites [23] Loprinzi, 2018, The effects of exercise on memory function among young to middle-aged adults: systematic review and recommendations for future research, Am J Health Promot. source

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    • cites [24] Song, 2018, The effectiveness of physical exercise on cognitive and psychological outcomes in individuals with mild cognitive impairment: A systematic review and meta-analysis, Int J Nurs Stud. source

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  • May combine two claims.

    Interpretationcitation

    Non-pharmacological treatment may improve function, independence, and quality of life in people with AD and dementia.

    “NPT may improve function, independence, and quality of life (QoL) in agreement with the International Classification of Functioning, Disability and Health (ICF) (9), is non-invasive, safe and has few side effects (10).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [9] World, 2001

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  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    A direct effect of non-pharmacological treatment on cognition through neural plasticity or adaptation cannot be excluded in early disease stages.

    “However, a direct effect of NPT on cognition through neural plasticity/adaptation cannot be excluded in early disease stages.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Regular physical exercise may improve physical health, reduce frailty, lower the risk of depression, and improve cognitive function in the short and long term in older adults.

    “Regular physical exercise is recommended to all older adults, and indeed to those at increased risk of AD, as it may improve physical health, reduce frailty, lower the risk of depression, improve cognitive function in the short and long term (26–31).”
    Quote in the paperSubstantial claim0 of 6 sources checked
    • cites [26] Bray, 2016, Exercise prescription to reverse frailty, Appl Physiol Nutr Metab. source

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    • cites [27] Santos-Lozano, 2016, Physical activity and Alzheimer disease: a protective association, Mayo Clin Proc. source

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    • cites [28] Schuch, 2016, Exercise for depression in older adults: a metaanalysis of randomized controlled trials adjusting for publication bias, Rev Bras Psiquiatr. source

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    • cites [29] Law, 2018, Moderate intensity physical activity associates with CSF biomarkers in a cohort at risk for Alzheimer's disease, Alzheimers Dement. source

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    • cites [30] Martins, 2018, Alzheimer's disease: a journey from amyloid peptides and oxidative stress, to biomarker technologies and disease prevention strategies-gains from AIBL and DIAN cohort studies, J Alzheimers Dis. source

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    • cites [31] Northey, 2018, Exercise interventions for cognitive function in adults older than 50: a systematic review with metaanalysis, Br J Sports Med. source

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    Premisecitation

    Non-pharmacological treatment is non-invasive, safe, and has few side effects.

    “NPT may improve function, independence, and quality of life (QoL) in agreement with the International Classification of Functioning, Disability and Health (ICF) (9), is non-invasive, safe and has few side effects (10).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [10] Poulos, 2017, A comprehensive approach to reablement in dementia, Alzheimers Dement. source

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    Premisecitation

    Exercise may improve vascular health by reducing blood pressure, arterial stiffness, oxidative stress, and systemic inflammation, and by enhancing endothelial dysfunction, all of which are associated with better cerebral perfusion.

    “It has been suggested that exercise may improve vascular health by reducing blood pressure (41, 42), arterial stiffness (42), oxidative stress (43), systemic inflammation (44), and enhance endothelial dysfunction (45), all of which are associated with better cerebral perfusion (46, 47).”
    Quote in the paperSubstantial claim0 of 7 sources checked
    • cites [41] Colcombe, 2004, Cardiovascular fitness, cortical plasticity, and aging, Proc Natl Acad Sci USA. source

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    • cites [42] Fleg, 2012, Aerobic exercise in the elderly: a key to successful aging, Discov Med.

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    • cites [43] Covas, 2002, Relationship between physical activity and oxidative stress biomarkers in women, Med Sci Sports Exerc. source

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    • cites [44] Lavie, 2011, Impact of physical activity, cardiorespiratory fitness, and exercise training on markers of inflammation, J Cardiopulm Rehabil Prev. source

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    • cites [45] Ghisi, 2010, Physical exercise and endothelial dysfunction, Arq Bras Cardiol. source

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    • cites [46] Churchill, 2002, Exercise, experience and the aging brain, Neurobiol Aging source

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    • cites [47] Davenport, 2012, Cerebrovascular reserve: the link between fitness and cognitive function?, Exerc Sport Sci Rev. source

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  • The quote only partly states this claim.

    Interpretationcitation

    The evidence on cognitive training for people with dementia is less robust than the evidence on cognitive stimulation.

    “The evidence on CT for people with dementia is less robust.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Physical activity is positively associated with gray matter volume in aging people, and aerobic fitness and coordinative exercises are associated with reduced brain atrophy in frontal and temporal regions and the hippocampus.

    “Imaging studies in aging people confirmed the positive association between physical activity and gray matter volume. Both aerobic fitness and coordinative exercises was associated with reduced brain atrophy in the frontal and temporal regions and the hippocampus, all areas that are critical for higher cognitive function (56–58).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [56] Weinstein, 2012, The association between aerobic fitness and executive functions is mediated by prefrontal cortex volume, Brain Behav Immun. source

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    • cites [57] Niemann, 2014, Not only cardiovascular, but also coordinative exercise increases hippocampal volume in older adults, Front Aging Neurosci. source

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    • cites [58] Papenberg, 2016, Physical activity and inflammation: effects on gray-matter volume and cognitive decline in aging, Hum Brain Mapp. source

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  • May combine two claims.

    Premisecitation

    Exercise may preserve neurons and promote neurogenesis, synaptogenesis, and neuronal plasticity.

    “Exercise may also preserve neurons and promote neurogenesis, synaptogenesis, (48–50), and neuronal plasticity (51–55).”
    Quote in the paperSubstantial claim0 of 8 sources checked
    • cites [48] Colcombe, 2003, Fitness effects on the cognitive function of older adults: a meta-analytic study, Psychol Sci. source

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    • cites [49] Kronenberg, 2006, Physical exercise prevents age-related decline in precursor cell activity in the mouse dentate gyrus, Neurobiol Aging source

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    • cites [50] Uda, 2006, Effects of chronic treadmill running on neurogenesis in the dentate gyrus of the hippocampus of adult rat, Brain Res. source

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    • cites [51] Cotman, 2002, Exercise: a behavioural intervention toenhance brain health and plasticity, Trends Neurosci. source

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    • cites [52] Vaynman, 2005, License to run: exercise impacts functional plasticity in the intact and injured central nervous system by using neurotrophins, Neurorehabil Neural Repair source

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    • cites [53] Cotman, 2007, Physical activity and the maintenance of cognition: learning from animal models, Alzheimers Dement source

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    • cites [54] Voelcker-Rehage, 2013, Structural and functional brain changes related to different types of physical activity across the life span, Neurosci Biobehav Rev. source

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    • cites [55] Hamaide, 2016, Neuroplasticity and MRI: a perfect match, Neuroimage source

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  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    Preserving functional independence in activities of daily living is critical for improving the quality of life of people with dementia and their caregivers and delaying institutionalization.

    “This finding is of some relevance because preserving functional independence in ADL is critical for improving the QoL of people with dementia and their caregivers and delaying institutionalization.”
    Quote in the paperNot a substantial claim

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    Premisecitation

    Brain-derived neurotrophic factor may be a common pathway mediating exercise-driven brain responses and can drive neuronal plasticity, improve cognition, and protect neurons against insult.

    “Neurotrophins, in particular the brain-derived neurotrophic factor, may be the common pathway of these mechanisms, may mediate the exercise-driven brain responses and can drive neuronal plasticity, improve cognition, and protect neurons against insult (60–63).”
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    • cites [60] Cheng, 2003, Nitric oxide acts in a positive feedback loop with BDNF to regulate neural progenitor cell proliferation and differentiation in the mammalian brain, Dev Biol. source

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    • cites [61] Vaynman, 2004, Hippocampal BDNF mediates the efficacy of exercise on synaptic plasticity and cognition, Eur J Neurosci. source

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    • cites [62] Erickson, 2012, Physical activity, brain plasticity, and Alzheimer's disease, Arch Med Res. source

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    • cites [63] Intlekofer, 2013, Exercise counteracts declining hippocampal function in aging and Alzheimer's disease, Neurobiol Dis. source

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    Premisecitation

    Cognitive training may improve patient's performance in trained tasks and similar exercises but has no consistent effect on everyday functioning.

    “A recent systematic review indicated that CT may improve patient's performance in trained tasks and similar exercises but has no consistent effect on everyday functioning (77).”
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    • cites [77] Kallio, 2017, Cognitive training interventions for patients with Alzheimer's disease: a systematic review, J Alzheimers Dis. source

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  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    Cognitive intervention is currently the non-pharmacological treatment that has been better explored in dementia and represents the most robust alternative and/or complement to pharmacological treatment.

    “Cognitive intervention is currently the NPT that has been better explored in dementia and represents the most robust alternative and/or complement to pharmacological treatment.”
    Quote in the paperNot a substantial claim

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    Premisecitation

    Most randomized controlled trials showed no effect of cognitive training on outcomes other than trained tasks, but their low quality impedes any solid conclusion.

    “Most RCTs showed no effect of CT on other outcomes, but their low quality impede any solid conclusion (70–72, 74, 77).”
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    • cites [70] Olazarán, 2010, Nonpharmacological therapies in Alzheimer's disease: a systematic review of efficacy, Dement Geriatr Cogn Disord. source

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    • cites [71] Kurz, 2011, The clinical significance of cognition-focused interventions for cognitively impaired older adults: a systematic review of randomized controlled trials, Int Psychogeriatr. source

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    • cites [72] Bahar-Fuchs, 2013, Cognitive training and cognitive rehabilitation for mild to moderate Alzheimer's disease and vascular dementia, Cochrane Database Syst Rev. source

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    • cites [74] Carrion, 2018, Cognitive Therapy for dementia patients: a systematic review, Dement Geriatr Cogn Disord. source

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    • cites [77] Kallio, 2017, Cognitive training interventions for patients with Alzheimer's disease: a systematic review, J Alzheimers Dis. source

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    Premisecitation

    Behavioral and psychological symptoms of dementia represent the most frequent cause of institutionalization and drug prescription, increase patient's disability, worsen patient's and caregiver's quality of life, and contribute to increased costs, but their influence on cognition is unclear.

    “BPSD represent the most frequent cause of institutionalization and drug prescription, increase patient's disability, worsen patient's and caregiver's QoL, contribute to increase costs, but their influence on cognition is unclear (92).”
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    • cites [92] Herrmann, 2006, The contribution of neuropsychiatric symptoms to the cost of dementia care, Int J Geriatr Psychiatry source

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    Premisereasoning

    The small body of evidence for massage and touch therapy suggests they could be viable treatment options, especially given the ease of implementation and minimal training involved.

    “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.”
    Quote in the paperSubstantial claim0 of 7 sources checked
    • cites [70] Olazarán, 2010, Nonpharmacological therapies in Alzheimer's disease: a systematic review of efficacy, Dement Geriatr Cogn Disord. source

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    • cites [99] O'Connor, 2009, Psychosocial treatments of behaviour symptoms in dementia: a systematic review of reports meeting quality standards, Int Psychogeriatr. source

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    • cites [103] O'Neil, 2011

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    • cites [104] Brodaty, 2012, Meta-analysis of nonpharmacological interventions for neuropsychiatric symptoms of dementia, Am J Psychiatry source

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    • cites [105] McLaren, 2013, Systematic review of non-pharmacologic interventions to delay functional decline in community-dwelling patients with dementia, Aging Ment Health source

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    • cites [106] Livingston, 2014, A systematic review of the clinical effectiveness and cost-effectiveness of sensory, psychological and behavioural interventions for managing agitation in older adults with dementia, Health Technol Assess. source

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    • cites [107] Abraha, 2017, Systematic review of systematic reviews of non-pharmacological interventions to treat behavioural disturbances in older patients with dementia, BMJ Open source

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    Premisecitation

    Behavioral and psychological symptoms of dementia are highly prevalent in all types of dementia: 50-80% in AD, >80% in fronto-temporal dementia, and 50-70% in Lewy body dementia and vascular dementia.

    “Behavioral and psychological symptoms of dementia, i.e., the so-called BPSD, are characterized by alterations of perception (hallucinations, misidentification), thinking (delusions), mood (depression, anxiety, apathy), and behavior (aggression, agitation, disinhibition, wandering, socially or sexually inappropriate behavior) (88), being highly prevalent in all types of dementia, i.e., 50–80% in AD”
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    • cites [89] Aalten, 2008, Consistency of neuropsychiatric syndromes across dementias: results from the European Alzheimer disease consortium, Dement Geriatr Cogn Disord. source

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    • cites [90] Kazui, 2016, Differences of behavioural and psychological symptoms of dementia in disease severity in four major dementias, PLoS ONE source

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    Premisecitation

    Behavioral and psychological symptoms of dementia may occur in all stages of AD and even in people with mild cognitive impairment, but there is no agreement on their possible relationship with disease evolution.

    “BPSD may occur in all stages of AD, and even in people with MCI, but there is no agreement on the possible relationship with disease evolution.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [89] Aalten, 2008, Consistency of neuropsychiatric syndromes across dementias: results from the European Alzheimer disease consortium, Dement Geriatr Cogn Disord. source

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    • cites [90] Kazui, 2016, Differences of behavioural and psychological symptoms of dementia in disease severity in four major dementias, PLoS ONE source

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    Premisecitation

    There are no conclusive results for validation and reminiscence therapy, the effectiveness of light therapy is not clear, and aromatherapy is better than no treatment for behavioral and psychological symptoms of dementia.

    “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.”
    Quote in the paperSubstantial claim0 of 7 sources checked
    • cites [70] Olazarán, 2010, Nonpharmacological therapies in Alzheimer's disease: a systematic review of efficacy, Dement Geriatr Cogn Disord. source

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    • cites [99] O'Connor, 2009, Psychosocial treatments of behaviour symptoms in dementia: a systematic review of reports meeting quality standards, Int Psychogeriatr. source

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    • cites [103] O'Neil, 2011

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    • cites [104] Brodaty, 2012, Meta-analysis of nonpharmacological interventions for neuropsychiatric symptoms of dementia, Am J Psychiatry source

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    • cites [105] McLaren, 2013, Systematic review of non-pharmacologic interventions to delay functional decline in community-dwelling patients with dementia, Aging Ment Health source

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    • cites [106] Livingston, 2014, A systematic review of the clinical effectiveness and cost-effectiveness of sensory, psychological and behavioural interventions for managing agitation in older adults with dementia, Health Technol Assess. source

      Not checked in the free run.

    • cites [107] Abraha, 2017, Systematic review of systematic reviews of non-pharmacological interventions to treat behavioural disturbances in older patients with dementia, BMJ Open source

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    Premisecitation

    All guidelines agree that individualized and person-centered non-pharmacological treatments are the first-line treatment for behavioral and psychological symptoms of dementia, and that pharmacological strategy should be considered only later, using the least harmful drug for the shortest time.

    “Considering the limited evidence and concerns on the safety of drug treatment (94–99), all guidelines agree that individualized and person-centered NPT are the first-line treatment for BPDS and the use of a pharmacological strategy should be considered only later, using the least harmful drug for the shortest time.”
    Quote in the paperSubstantial claim0 of 6 sources checked
    • cites [94] Sorbi, 2012, EFNS-ENS guidelines on the diagnosis and management of disorders associated with dementia, Eur J Neurol. source

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    • cites [96] Gauthier, 2010, Management of behavioral problems in Alzheimer's disease, Int Psychogeriatr source

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    • cites [97] Seitz, 2013, Pharmacological treatments for neuropsychiatric symptoms of dementia in long-term care: a systematic review, Int Psychogeriatr. source

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    • cites [98] Sultzer, 2008, Clinical symptom responses to atypical antipsychotic medications in Alzheimer's disease: phase 1 outcomes from the CATIE-AD effectiveness trial, Am J Psychiatry source

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    • cites [99] O'Connor, 2009, Psychosocial treatments of behaviour symptoms in dementia: a systematic review of reports meeting quality standards, Int Psychogeriatr. source

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    Premisecitation

    Music therapy and behavioral management techniques seem to cause a short-term reduction of behavioral and psychological symptoms of dementia, but long-term efficacy is unclear.

    “Music therapy and behavioral management techniques seem to cause a short-term reduction of BPSD, but long-term efficacy is unclear.”
    Quote in the paperSubstantial claim0 of 7 sources checked
    • cites [70] Olazarán, 2010, Nonpharmacological therapies in Alzheimer's disease: a systematic review of efficacy, Dement Geriatr Cogn Disord. source

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    • cites [99] O'Connor, 2009, Psychosocial treatments of behaviour symptoms in dementia: a systematic review of reports meeting quality standards, Int Psychogeriatr. source

      Not checked in the free run.

    • cites [103] O'Neil, 2011

      Not checked in the free run.

    • cites [104] Brodaty, 2012, Meta-analysis of nonpharmacological interventions for neuropsychiatric symptoms of dementia, Am J Psychiatry source

      Not checked in the free run.

    • cites [105] McLaren, 2013, Systematic review of non-pharmacologic interventions to delay functional decline in community-dwelling patients with dementia, Aging Ment Health source

      Not checked in the free run.

    • cites [106] Livingston, 2014, A systematic review of the clinical effectiveness and cost-effectiveness of sensory, psychological and behavioural interventions for managing agitation in older adults with dementia, Health Technol Assess. source

      Not checked in the free run.

    • cites [107] Abraha, 2017, Systematic review of systematic reviews of non-pharmacological interventions to treat behavioural disturbances in older patients with dementia, BMJ Open source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A home-based individualized Cognitive Stimulation Therapy program had neither effect on cognition and quality of life of patients with mild-to-moderate dementia, nor on quality of life of their caregivers.

    “However, a recent RCT showed that a home-based iCST program had neither effect on cognition and QoL of patients with mild-to-moderate dementia, nor on QoL of their caregivers (87).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [87] Orrell, 2017, The impact of individual Cognitive Stimulation Therapy (iCST) on cognition, quality of life, caregiver health, and family relationships in dementia: a randomised controlled trial, PLoS Med. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Potential benefits of non-pharmacological treatments for behavioral and psychological symptoms of dementia have been documented, but the strength of evidence is overall low and heterogeneity in intervention type, follow-up duration, and outcome measures hampers comparison across studies.

    “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.”
    Quote in the paperSubstantial claim0 of 7 sources checked
    • cites [70] Olazarán, 2010, Nonpharmacological therapies in Alzheimer's disease: a systematic review of efficacy, Dement Geriatr Cogn Disord. source

      Not checked in the free run.

    • cites [99] O'Connor, 2009, Psychosocial treatments of behaviour symptoms in dementia: a systematic review of reports meeting quality standards, Int Psychogeriatr. source

      Not checked in the free run.

    • cites [103] O'Neil, 2011

      Not checked in the free run.

    • cites [104] Brodaty, 2012, Meta-analysis of nonpharmacological interventions for neuropsychiatric symptoms of dementia, Am J Psychiatry source

      Not checked in the free run.

    • cites [105] McLaren, 2013, Systematic review of non-pharmacologic interventions to delay functional decline in community-dwelling patients with dementia, Aging Ment Health source

      Not checked in the free run.

    • cites [106] Livingston, 2014, A systematic review of the clinical effectiveness and cost-effectiveness of sensory, psychological and behavioural interventions for managing agitation in older adults with dementia, Health Technol Assess. source

      Not checked in the free run.

    • cites [107] Abraha, 2017, Systematic review of systematic reviews of non-pharmacological interventions to treat behavioural disturbances in older patients with dementia, BMJ Open source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In people with mild-to-moderate dementia, the area of major Cognitive Stimulation Therapy efficacy is general cognitive functioning, with memory, orientation, and language comprehension showing larger improvement in an open study.

    “Several studies suggested the area of major CST efficacy in people with mild-to-moderate dementia is general cognitive functioning, but some cognitive areas, namely memory, orientation and language comprehension seems to be those with larger improvement following CST in an open study (84).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [84] Hall, 2013, Cognitive Stimulation Therapy (CST): neurpsychological mechanisms of change, Int Psychogeriatr. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The competence-environmental press model suggests that the right balance between individual ability and external environmental demands results in adaptive behaviors, while excessive or reduced environmental activities may result in behavioral and psychological symptoms of dementia.

    “According to the competence-environmental press (CEP) model, the highest individual functioning results from optimal combinations of environmental conditions and personal competencies. The CEP model suggests that the right balance between individual ability and external environmental demands results in adaptive behaviors, while excessive or reduced environmental activities may result in BPSD.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [100] Gitlin, 2010

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The need-driven, dementia-compromised behavior model conceptualizes behavioral and psychological symptoms of dementia as the result of the combination between the caregiver's inability to understand the patient's needs and the patient's inability to express them, and suggests that BPSD may represent attempts to express physical or emotional distress due to unmet needs.

    “A different approach is provided by the need-driven, dementia-compromised behavior (NDB) that conceptualized BPSD as the result of the combination between the inability of the caregiver to understand patient's needs and the inability of the patient to express them. Therefore, BPSD may represent patient's attempts to express physical or emotional distress due to unmet needs.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [101] Norton, 1996, Need-driven dementia-compromised behavior: an alternative view of disruptive behavior, Am J Alzheimer's Dis Other Dem. source

      Not checked in the free run.

    • cites [102] Kovach, 2005, A model of consequences of need-driven, dementia-compromised behavior, J Nurs Scholarsh. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Factors that may predict a better response to non-pharmacological treatments for behavioral and psychological symptoms of dementia include a higher level of cognitive functioning, fewer difficulties in activities of daily living and communication, and relative preservation of speech, while staff barriers and pain are associated with worse outcome.

    “Factors that may predict a better response to these interventions include a higher level of cognitive functioning, fewer difficulties in ADL and communication, and relative preservation of speech, while staff barriers and pain are associated to worse outcome (108).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [108] Cohen-Mansfield, 2014, Predictors of the impact of nonpharmacologic interventions for agitation in nursing home residents with advanced dementia source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Psychological interventions added to usual care can reduce symptoms of depression and clinician-rated anxiety in dementia and have the potential to improve patient's well-being, but have no effect on activities of daily living, self- and caregiver-rated patient's quality of life, behavioral and psychological symptoms of dementia, cognition, or caregivers' self-reported depressive symptoms.

    “The Authors concluded that there is evidence that psychological interventions added to usual care can reduce symptoms of depression and clinician-rated anxiety in dementia and that psychological interventions have the potential to improve patient's well-being, while no effect was found on ADL, self- and caregiver-rated patient's QoL, BPSD, cognition, or caregivers' self-reported depressive symptom”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [163] Orgeta, 2014, Psychological treatments for depression and anxiety in dementia and mild cognitive impairment, Cochrane Database Syst Rev. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The presence of apathy is related to greater caregiver burden, faster functional impairment, reduced quality of life, and increased morbidity, and is a reliable longitudinal predictor of death in people with dementia.

    “The presence of apathy seems to be related to greater caregiver burden, faster functional impairment, reduced QoL and increased morbidity, being a reliable longitudinal predictor of death in people with dementia (155–157).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [155] Spalletta, 2015, Longitudinal neuropsychiatric predictors of death in Alzheimer's disease, J Alzheimers Dis. source

      Not checked in the free run.

    • cites [156] Dauphinot, 2015, Risk factors of caregiver burden among patients with Alzheimer's disease or related disorders: a cross-sectional study, J Alzheimers Dis. source

      Not checked in the free run.

    • cites [157] Hongisto, 2018, Quality of Life in relation to neuropsychiatric symptoms in Alzheimer's disease: 5-year prospective ALSOVA cohort study, Int J Geriatr Psychiatry source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Apathy is one of the most common neuropsychiatric symptoms in AD, with a prevalence ranging from 19 to 88%.

    “Apathy, which is defined as a loss or diminution of goal-directed behavior, cognition or emotion (152) is one the of the most common neuropsychiatric symptom in AD, with a prevalence ranging from 19 to 88% (153).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [153] Salzman, 2008, Elderly patients with dementia-related symptoms of severe agitation and aggression: consensus statement on treatment options, clinical trials methodology, and policy, J Clin Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Occupational therapy seems effective in reducing behavioral and psychological symptoms of dementia, increasing patient's participation, improving physical performance and quality of life, and reducing negative communication.

    “OT seems also effective in reducing BPSD, increasing patient's participation, improving physical performance, and QoL and reducing negative communication (123–129).”
    Quote in the paperSubstantial claim0 of 7 sources checked
    • cites [123] Gitlin, 2010, The cost-effectiveness of a nonpharmacologic intervention for individuals with dementia and family caregivers: the tailored activity program, Am J Geriatr Psychiatry source

      Not checked in the free run.

    • cites [124] Kolanowski, 2001, A randomized clinical trial of theory-based activities for the behavioural symptoms of dementia in nursing home residents, J Am Geriatr Soc. source

      Not checked in the free run.

    • cites [125] Rao, 2014, Systematic review of the effects of exercise on activities of daily living in people with Alzheimer's disease, Am J Occup Ther. source

      Not checked in the free run.

    • cites [126] Rao, 2014, Occupational therapy in chronic progressive disorders: enhancing function and modifying disease, Am J Occup Ther. source

      Not checked in the free run.

    • cites [127] Pimouguet, 2017, Benefits of occupational therapy in dementia patients: findings from a real-world observational study, J Alzheimers Dis. source

      Not checked in the free run.

    • cites [128] Gitlin, 2008, Tailored activities to manage neuropsychiatry behavior in persons with dementia and reduce caregiver burden, Am J Geriatr Psychiatry source

      Not checked in the free run.

    • cites [129] Gitlin, 2018, Targeting behavioral symptoms and functional decline in dementia: a randomized clinical trial, J Am Geriatr Soc. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The current evidence for psychological support and psychotherapy in AD and dementia is limited and not conclusive.

    “In conclusion, the current evidence for psychological support and psychotherapy in AD and dementia is limited and not conclusive.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Experiencing depression and anxiety is very common in people with dementia, even if there is a lack of consensus on their prevalence rates because diagnostic criteria may vary among studies.

    “Actually, experiencing depression and anxiety is very common in people with dementia, even if there is a lack of consensus on their prevalence rates as diagnostic criteria may vary among studies (144–147).”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [144] Enache, 2011, Depression in dementia: epidemiology, mechanisms, and treatment, Curr Opin Psychiatry source

      Not checked in the free run.

    • cites [145] Weiner, 2002, Prevalence and incidence of major depressive disorder in Alzheimer's disease: findings from two databases, Dement Geriatr Cog Disord. source

      Not checked in the free run.

    • cites [146] Starkstein, 2005, The construct of minor and major depression in Alzheimer's disease, Am J Psychiatry source

      Not checked in the free run.

    • cites [147] Hwang, 2004, Mild cognitive impairment is associated with characteristic neuropsychiatric symptoms, Alzheimer Dis Assoc Disord. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Anxiety is associated with decreased independence and increased risk of nursing home placement in people with dementia.

    “Consistent evidence suggests that, in people with dementia, the severity of depression increases the severity of neurological impairment, institutionalization (148, 149), and caregiver burden (150), while anxiety is associated with decreased independence and increased risk of nursing home placement (151).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [151] Rozzini, 2009, Int J Geriatr Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Interpretationnone given

    The proposed psychological approaches were methodologically heterogeneous, some lacked specificity and conceptual clarity, and descriptions of the interventions were often generic.

    “Overall, the proposed psychological approaches were methodologically heterogeneous, some of them lacked specificity and conceptual clarity and often the description of the interventions was quite generic.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Disease progression reduces the ability to participate in occupations-mainly activities of daily living, instrumental activities of daily living, leisure, and social activities-in patients with dementia, leading to a negative impact on quality of life and well-being of patients and caregivers.

    “Disease progression reduces the ability to participate in occupations—mainly ADL, IADL, leisure and social activities—in patients with dementia, leading to a negative impact on QoL and well-being of patients and caregivers (113–117).”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [113] Muò, 2005, Alzheimer's disease-associated disability: an ICF approach, Disabil Rehabil. source

      Not checked in the free run.

    • cites [114] Giebel, 2014, Deterioration of basic activities of daily living and their impact on quality of life across different cognitive stages of dementia: a European study, Int Psychogeriatr. source

      Not checked in the free run.

    • cites [115] Prizer, 2018, Progressive support for activities of daily living for persons living with dementia, Gerontologist source

      Not checked in the free run.

    • cites [116] Sun, 2018, The association between cognitive fluctuations and activities of daily living and quality of life among institutionalized patients with dementia, Int J Geriatr Psychiatry source

      Not checked in the free run.

    • cites [117] Egan, 2006, Dementia and occupation: a review of the literature, Can J Occupat Ther. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In people with dementia, the severity of depression increases the severity of neurological impairment, institutionalization, and caregiver burden.

    “Consistent evidence suggests that, in people with dementia, the severity of depression increases the severity of neurological impairment, institutionalization (148, 149), and caregiver burden (150), while anxiety is associated with decreased independence and increased risk of nursing home placement (151).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [148] Schultz, 2004, Anxiety and impaired social function in the elderly, Ann Clin Psychiatry source

      Not checked in the free run.

    • cites [149] Gabryelewicz, 1998, Prevalence of major and minor depression in elderly persons with mild cognitive impairment–MADRS factor analysis, Int J Geriatr Psychiatry source

      Not checked in the free run.

    • cites [150] Lu, 2009, Donepezil delays progression to AD in MCI subjects with depressive symptoms, Neurology source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Systematic reviews indicated a variety of non-pharmacological treatments-one-to-one activities, activity programs tailored on patients' preferences, individualized cognitive rehabilitation, music therapy, and art therapy-as potentially effective and safe in reducing apathy, although none of them is strictly a psychological intervention.

    “Systematic reviews indicated a variety of NPTs (e.g., one-to-one activities, activity programs tailored on patients' preferences, individualized cognitive rehabilitation, music therapy, art therapy) as potentially effective and safe in reducing apathy, although none of them is strictly a psychological intervention (165, 166).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [165] Goris, 2016, Quantitative systematic review of the effects of non-pharmacological interventions on reducing apathy in persons with dementia, J Adv Nurs. source

      Not checked in the free run.

    • cites [166] Theleritis, 2018, A systematic review of non-pharmacological treatments for apathy in dementia, Int J Geriatr Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Pain and discomfort may cause difficulties in communication and self-management and contribute to behavioral and psychological symptoms of dementia.

    “Since pain and discomfort may cause difficulties in communication and self-management, and contribute to BPSD, these factors should be carefully searched and treated (111, 112).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [111] Cohen-Mansfield, 2012, Assessment and treatment of behaviour problems in dementia in nursing home residents: a comparison of the approaches of physicians, psychologists and nurse practitioners, Int J Geriatr Psychiatry source

      Not checked in the free run.

    • cites [112] Cohen-Mansfield, 2015, Which unmet needs contribute to behaviour problems in persons with advanced dementia?, Psychiatry Res. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A multimodal occupational therapy approach including cognitive and behavioral interventions was effective in improving activities of daily living and reducing caregiver burden in patients with mild-to-moderate dementia living in the community, with effects lasting up to 12 weeks.

    “An RCT on patients with mild-to-moderate dementia living in the community showed that a multimodal OT approach, including cognitive and behavioral interventions to train patients to compensate for cognitive impairment and caregivers to cope with patients' abnormal behavior, was effective in improving ADL and in reducing caregiver's burden with effects lasting for up to 12 weeks (121).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [121] Graff, 2006, Community based occupational therapy for patients with dementia and their caregivers: randomised controlled trial, BMJ source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Ambient music, aromatherapy, and Snoezelen are modestly effective in reducing agitation but do not have long-term effects, while evidence to support bright light therapy for mood and sleep disorders is only preliminary.

    “Among environment-based interventions, ambient music, aromatherapy, and Snoezelen (i.e., a soothing and stimulating multisensory environment) were modestly effective in reducing agitation, but they did not have long-term effects, while the evidence to support bright light therapy for mood and sleep disorders was only preliminary (131).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [131] Padilla, 2011, Effectiveness of environment-based interventions for people with Alzheimer's disease and related dementias, Am J Occup Ther. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The strongest evidence supports the use of short-term group therapy soon after dementia diagnosis to reduce levels of depression and enhance quality of life, while tailored and multi-component interventions seem to reduce inappropriate behaviors in patients living in nursing homes with mild-to-moderate levels of impairment.

    “A recent systematic review concluded that the strongest evidence supported the use of short-term group therapy soon after dementia diagnosis to reduce levels of depression and enhance QoL, while tailored and multi-component interventions seemed to reduce inappropriate behaviors in patients living in nursing homes with mild-to-moderate levels of impairment (164).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [164] Cheston, 2017, Int J Geriatr Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The Tailored Activity Program was effective in reducing caregiver burden and was highly cost-effective.

    “Besides being effective in reducing caregiver burden, in that caregiver had significantly more free time, TAP was demonstrated to be highly cost-effective (123).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [123] Gitlin, 2010, The cost-effectiveness of a nonpharmacologic intervention for individuals with dementia and family caregivers: the tailored activity program, Am J Geriatr Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Empirical evidence supporting the efficacy of psychological interventions in dementia is rather sparse, mainly because reviews included a broad group of interventions that are not based on well-defined theory-driven psychological interventions.

    “However, empirical evidence supporting the efficacy of psychological interventions is rather sparse (159), mainly because a broad group of interventions that are termed as psychological ones have been included in reviews (160, 161), but actually are not based on well-defined theory-driven psychological interventions.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [159] Doody, 2001, Practice parameter: management of dementia (an evidence-based review), Neurology source

      Not checked in the free run.

    • cites [160] Lyketsos, 2002, Depression in Alzheimer's disease: overview and treatment, Biol Psychiatry source

      Not checked in the free run.

    • cites [161] Douglas, 2004, Non-pharmacological interventions in dementia, Adv Psychiatr Treat source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The Meeting Centers Support Program yielded promising results in terms of user satisfaction, reduction of patients' behavioral and emotional disturbances, decrease of caregivers' burden, and delayed institutionalization.

    “MCSP yielded promising results in terms of user satisfaction, reduction of patients' behavioral and emotional disturbances, decrease of caregivers' burden and delayed institutionalization (170–173).”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [170] Dröes, 2000, The effect of integrated family support versus day care only on behavior and mood of patients with dementia, Int Psychogeriatr. source

      Not checked in the free run.

    • cites [171] Dröes, 2004, Effect of Meeting Centres Support Programme on feeling of competence of family caregivers and delay of institutionalization of people with dementia, Aging Ment Health source

      Not checked in the free run.

    • cites [172] Dröes, 2004, Effect of combined support for people with dementia and carers versus regular day care on behaviour and mood of persons with dementia: results from a multi-centre implementation study, Int J Geriatr Psychiatry source

      Not checked in the free run.

    • cites [173] Dröes, 2011, An evaluation of the Meeting Centres Support Programme among persons with dementia and their carers, Nonpharmacol Therapies Dementia

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A meta-analysis identified only seven randomized controlled trials and concluded that the benefits of aromatherapy for people with dementia are equivocal, mainly because of severe methodological problems.

    “A meta-analysis identified only seven RCTs and concluded that the benefits of aromatherapy for people with dementia are equivocal, mainly because of severe methodological problems (191).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [191] Forrester, 2014, Aromatherapy for dementia, Cochrane Database Syst Rev. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    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, and in hospitalized older adults with cognitive impairment.

    “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).”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [70] Olazarán, 2010, Nonpharmacological therapies in Alzheimer's disease: a systematic review of efficacy, Dement Geriatr Cogn Disord. source

      Not checked in the free run.

    • cites [175] Smits, 2007, Effects of combined intervention programmes for people with dementia living at home and their caregivers: a systematic review, Int J Geriatric Psychiatry source

      Not checked in the free run.

    • cites [176] Klapwijk, 2018, Change in quality of life after a multidisciplinary intervention for people with dementia: a cluster randomized controlled trial, Int J Geriatr Psychiatry source

      Not checked in the free run.

    • cites [177] Sinvani, 2018, A multicomponent model to improve hospital care of older adults with cognitive impairment: a propensity score-matched analysis, J Am Geriatr Soc. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Music facilitates communicative and relational processes and emotional expression.

    “From a psychological point of view, music facilitates communicative and relational processes and emotional expression (206).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [206] Gold, 2009, Dose-response relationship in music therapy for people with serious mental disorders; systematic review and meta-analysis, Clin Psychol Rev. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationcitation

    Since most studies on music therapy included both active and passive techniques, which type of intervention can be more effective in dementia is still unclear.

    “Since most studies on MT included both active and passive techniques, which type of intervention can be more effective in dementia is still unclear (193).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [193] Raglio, 2018, Music listening for people living with dementia, J Am Med Dir Assoc. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Music can stimulate both motor and cognitive functions, so it can be an efficient tool for rehabilitation.

    “Moreover, since music can stimulate both motor and cognitive functions, it can be an efficient tool for rehabilitation (207).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [207] Schlaug, 2009, Part VI introduction: listening to and making music facilitates brain recovery processes, Ann N Y Acad Sci. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Aromatherapy has been used to address behavioral and psychological symptoms of dementia, sleep disturbances, and to stimulate motivational behavior in people with dementia.

    “Indeed, aromatherapy has been used to address BPSD (181–186) and sleep disturbances (187–189) and to stimulate motivational behavior (190).”
    Quote in the paperNot a substantial claim0 of 10 sources checked
    • cites [181] Brooker, 1997, Single case evaluation of the effects of aromatherapy and massage on disturbed behaviour in severe dementia, Br J Clin Psychol. source

      Not checked in the free run.

    • cites [182] Ballard, 2002, Aromatherapy as a safe and effective treatment for the management of agitation in severe dementia: the results of a double-blind, placebo-controlled trial with Melissa, J Clin Psychiatry source

      Not checked in the free run.

    • cites [183] Lin, 2007, Efficacy of aromatherapy (Lavandula angustifolia) as an intervention for agitated behaviours in Chinese older persons with dementia: a cross-over randomized trial, Int J Geriatr Psychiatry source

      Not checked in the free run.

    • cites [184] Nguyen, 2008, The use of aromatherapy to treat behavioural problems in dementia, Int J Geriatr Psychiatry source

      Not checked in the free run.

    • cites [185] Yang, 2015, Comparison of the efficacy of aroma-acupressure and aromatherapy for the treatment of dementia-associated agitation, BMC Complement Altern Med. source

      Not checked in the free run.

    • cites [186] VilelaI, 2017, What do Cochrane systematic reviews say about non-pharmacological interventions for treating cognitive decline and dementia?, Sao Paulo Med J. source

      Not checked in the free run.

    • cites [187] Wolfe, 1996, Can aromatherapy oils promote sleep in severely demented patients?, Int J Geriatr Psychiatry source

      Not checked in the free run.

    • cites [188] Johannessen, 2013, Nurses experience of aromatherapy use with dementia patients experiencing disturbed sleep patterns. An action research project, Complement Ther Clin Pract. source

      Not checked in the free run.

    • cites [189] Takeda, 2017, Effects of inhalation aromatherapy on symptoms of sleep disturbance in the elderly with dementia, Evid Based Complement Alternat Med. source

      Not checked in the free run.

    • cites [190] MacMahon, 1998, A clinical trial of the effects of aromatherapy on motivational behaviour in a dementia care setting using a single subject design, Aust J Holist Nurs.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Evidence suggests that massage and touch may improve appetite, sleep and communication problems.

    “Evidence suggests that massage and touch may relax older people with dementia, reduce some BPSD, such as pacing, wandering and resisting care, improve appetite, sleep and communication problems, and, to some extent, counteract cognitive decline (244–250).”
    Quote in the paperSubstantial claim0 of 7 sources checked
    • cites [244] Rowe, 1999, The effectiveness of slow-stroke massage in diffusing agitated behaviours in individuals with Alzheimer's disease, J Gerontol Nurs. source

      Not checked in the free run.

    • cites [245] Remington, 2002, Calming music and hand massage with agitated elderly, Nurs Res. source

      Not checked in the free run.

    • cites [246] Nelson, 2004, The power of human touch in Alzheimer's care, Massage Ther J.

      Not checked in the free run.

    • cites [247] Moyle, 2011, Exploring the effect of foot massage on agitated behaviours in older people with dementia: a pilot study, Aust J Ageing source

      Not checked in the free run.

    • cites [248] Rodríguez-Mansilla, 2015, The effects of ear acupressure, massage therapy and no therapy on symptoms of dementia: a randomized controlled trial, Clin Rehabil. source

      Not checked in the free run.

    • cites [249] Moyle, 2014, Foot massage and physiological stress in people with dementia: a randomized controlled trial, J Altern Complement Med. source

      Not checked in the free run.

    • cites [250] Kapoor, 2015, Effect of therapeutic massage on pain in patients with dementia, Dementia source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    The effect of music was found to be no more beneficial than other pleasant activities.

    “However, reviews on this topic pointed out the methodological limitations and the scarce quality of previous studies and questioned the specificity of the effect of music that was found to be no more beneficial than other pleasant activities (223, 224).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [223] Baird, 2015, Music and dementia, Prog Brain Res. source

      Not checked in the free run.

    • cites [224] Samson, 2015, Efficacy of musical interventions in dementia: methodological requirements of non-pharmacological trials, Ann NY Acad Sci. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The question whether music may have specific effects in patients with dementia is still open.

    “In conclusion, the question whether music may have specific effects in patients with dementia is still open.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Art therapy can engage attention and provide pleasure in dementia.

    “Case reports, observational studies, small trials and anecdotal evidence suggest that art therapy can engage attention, provide pleasure, and improve BPSD, social behavior, and self-esteem, contributing to the individual sense of well-being in dementia, and that these effects may be long-lasting (230–243).”
    Quote in the paperSubstantial claim0 of 10 sources checked
    • cites [230] Sterritt, 1994, Art activities for patients with Alzheimer's and related disorders, Geriatr Nurs. source

      Not checked in the free run.

    • cites [231] Rentz, 2002, Memories in the making: outcome-based evaluation of an art program for individuals with dementing illnesses, Am J Alzheimers Dis Other Demen. source

      Not checked in the free run.

    • cites [232] Bonner, 2006

      Not checked in the free run.

    • cites [233] Hannemann, 2006, Creativity with dementia patients, Gerontology source

      Not checked in the free run.

    • cites [234] Rusted, 2006, A multi-centre randomized control group trial on the use of art therapy for older people with dementia, Group Analysis source

      Not checked in the free run.

    • cites [235] Flood, 2007, Creativity in older adults: a plethora of possibilities, Issues Ment Health Nurs. source

      Not checked in the free run.

    • cites [236] Schmitt, 2007, Creative therapy options for patients with dementia–a systematic review, Fortschr Neurol Psychiatr. source

      Not checked in the free run.

    • cites [237] Cummings, 2008, Creativity and dementia: emerging diagnostic and treatment methods for Alzheimer's disease, CNS Spectr.

      Not checked in the free run.

    • cites [238] Stoukides, 2008, Creative and sensory therapies enhance the lives of people with Alzheimers, Med Health R I.

      Not checked in the free run.

    • cites [239] Peisah, 2001, Creative solutions for severe dementia with BPSD: a case of art therapy used in an inpatient and residential care setting, Int Psychogeriatr. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Art therapy can improve BPSD, social behavior, and self-esteem in dementia.

    “Case reports, observational studies, small trials and anecdotal evidence suggest that art therapy can engage attention, provide pleasure, and improve BPSD, social behavior, and self-esteem, contributing to the individual sense of well-being in dementia, and that these effects may be long-lasting (230–243).”
    Quote in the paperSubstantial claim0 of 10 sources checked
    • cites [230] Sterritt, 1994, Art activities for patients with Alzheimer's and related disorders, Geriatr Nurs. source

      Not checked in the free run.

    • cites [231] Rentz, 2002, Memories in the making: outcome-based evaluation of an art program for individuals with dementing illnesses, Am J Alzheimers Dis Other Demen. source

      Not checked in the free run.

    • cites [232] Bonner, 2006

      Not checked in the free run.

    • cites [233] Hannemann, 2006, Creativity with dementia patients, Gerontology source

      Not checked in the free run.

    • cites [234] Rusted, 2006, A multi-centre randomized control group trial on the use of art therapy for older people with dementia, Group Analysis source

      Not checked in the free run.

    • cites [235] Flood, 2007, Creativity in older adults: a plethora of possibilities, Issues Ment Health Nurs. source

      Not checked in the free run.

    • cites [236] Schmitt, 2007, Creative therapy options for patients with dementia–a systematic review, Fortschr Neurol Psychiatr. source

      Not checked in the free run.

    • cites [237] Cummings, 2008, Creativity and dementia: emerging diagnostic and treatment methods for Alzheimer's disease, CNS Spectr.

      Not checked in the free run.

    • cites [238] Stoukides, 2008, Creative and sensory therapies enhance the lives of people with Alzheimers, Med Health R I.

      Not checked in the free run.

    • cites [239] Peisah, 2001, Creative solutions for severe dementia with BPSD: a case of art therapy used in an inpatient and residential care setting, Int Psychogeriatr. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Whether art therapy can be useful and may represent an effective rehabilitative strategy for people suffering from dementia is a debated issue.

    “Whether art therapy can be useful and may represent an effective rehabilitative strategy for people suffering from dementia is a debated issue (228, 110).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [228] Chancellor, 2014, Art therapy for Alzheimer's disease and other dementias, J Alzheimers Dis. source

      Not checked in the free run.

    • cites [110] Scales, 2018, Evidence-based nonpharmacological practices to address behavioural and psychological symptoms of dementia, Gerontologist source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Effects of a music-based therapeutic intervention on anxiety or social behavior, and long-term effects, are unclear in dementia.

    “A recent meta-analysis concluded that a music-based therapeutic intervention probably reduces depressive symptoms but has little or no effect on agitation or aggression, emotional well-being or QoL, overall behavioral problems and cognition in dementia, while effects on anxiety or social behavior, and long-term effects are unclear (192).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [192] van, 2017, Cochrane Database Syst Rev. source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    A music-based therapeutic intervention has little or no effect on agitation or aggression, emotional well-being or QoL, overall behavioral problems and cognition in dementia.

    “A recent meta-analysis concluded that a music-based therapeutic intervention probably reduces depressive symptoms but has little or no effect on agitation or aggression, emotional well-being or QoL, overall behavioral problems and cognition in dementia, while effects on anxiety or social behavior, and long-term effects are unclear (192).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [192] van, 2017, Cochrane Database Syst Rev. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationnone given

    Few high-quality studies have been performed on art therapy, and there is too little empirical evidence to prove its effectiveness.

    “However, few high-quality studies have been performed so far on this topic, and there is too little empirical evidence to prove the effectiveness of this type of CAM.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    A systematic review on the ethical and practical concerns of surveillance technologies in residential care for people with dementia concluded that there is no consensus and underlined the need for clearer policies.

    “A systematic review on the ethical and practical concerns of surveillance technologies in residential care for people with dementia concluded that there is no consensus and underlined the need for clearer policies on this topic (274).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [274] Niemeijer, 2010, Ethical and practical concerns of surveillance technologies in residential care for people with dementia or intellectual disabilities: an overview of the literature, Int Psychogeriatr. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The relatively small sample size and low quality of included studies do not allow a firm conclusion on the effect of massage and touch on BPSD or any useful suggestion for clinical practice.

    “A recent meta-analysis of 11 RCTs showed that massage and touch interventions may have significant effect on physical non-aggressive, verbal aggressive and non-aggressive behavior, but the relatively small sample size and the low quality of the included studies do not allow to draw a firm conclusion on the effect on BPSD or any useful suggestion for clinical practice (253).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [253] Wu, 2017, The effectiveness of massage and touch on behavioural and psychological symptoms of dementia: a quantitative systematic review and meta-analysis, J Adv Nurs. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Many studies in this area focused on the perspective of relatives and/or healthcare staff, but only a limited number explored the experience of people when wearing a GPS tracking technology.

    “Many studies in this area focused on the perspective of relatives and/or healthcare staff, but only a limited number of them explored the experience of people when wearing a GPS tracking technology (259, 262, 268, 269).”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [259] Pilotto, 2011, J Alzheimers Dis. source

      Not checked in the free run.

    • cites [262] Faucounau, 2009, Electronic tracking system and wandering in Alzheimer's disease: a case study, Ann Phys Rehabil Med. source

      Not checked in the free run.

    • cites [268] Robinson, 2007, Balancing rights and risks: conflicting perspectives in the management of wandering in dementia, Health Risk Soc. source

      Not checked in the free run.

    • cites [269] Landau, 2009, Attitudes of family and professional care-givers towards the use of GPS for tracking patients with dementia: an exploratory study, Br J Soc Work source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Sensors measuring electrodermal activity could early detect agitation in persons with dementia.

    “Sensors measuring electrodermal activity could early detect agitation in persons with dementia.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [289] Melander, 2017, Measuring electrodermal activity to improve the identification of agitation in individuals with dementia, Dement Geriatr Cogn Disord Extra source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Devices can be used for surveillance and management of high-risk behaviors and may replace more severe forms of physical restraints.

    “Another application of ICT is represented by devices that can be used for surveillance and management of high-risk behaviors and may replace more severe forms of physical restraints (270–272).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [270] Niemeijer, 2011, The ideal application of surveillance technology in residential care for people with dementia, J Med Ethics source

      Not checked in the free run.

    • cites [271] Zwijsen, 2012, Surveillance technology: an alternative to physical restraints? A qualitative study among professionals working in nursing homes for people with dementia, Int J Nurs Stud. source

      Not checked in the free run.

    • cites [272] Te, 2013, Quality of life of nursing-home residents with dementia subject to surveillance technology versus physical restraints: an explorative study, Int J Geriatr Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Video processing technologies can be adopted to obtain pragmatic, ecological, and objective measures to improve assessment of ADL, and to provide additional information that cannot be gathered in a clinical setting.

    “Video processing technologies can be adopted to obtain pragmatic, ecological, and objective measures to improve assessment of ADL, and to provide additional information that cannot be gathered in a clinical setting (285).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [285] Sacco, 2012, Detection of activities of daily living impairment in Alzheimer's disease and mild cognitive impairment using information and communication technology, Clin Interv Aging source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisenone given

    Physiological models suggest that the effects of massage may be mediated by the production of oxytocin, which can reduce discomfort, agitation, blood pressure and heart rate, and improve mood.

    “Physiological models suggest that the effects of massage may be mediated by the production of oxytocin that can reduce discomfort, agitation, blood pressure and heart rate, and improve mood.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Recent technological advances in ICT increased the availability of intelligent devices and technology-embedded environments to support the daily life of persons with dementia and their caregivers, and to assess disease severity and progression.

    “Recent technological advances in ICT, including computational devices, robotics, machine learning algorithms, miniaturization of sensors and technologies, as well as the reduced costs of these devices increased the availability of intelligent devices and technology-embedded environments to support the daily life of persons with dementia and their caregivers, and to assess disease severity and ProG”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [254] Culler, 2004, Guest editors' introduction: overview of sensor networks, Computer source

      Not checked in the free run.

    • cites [255] Cooper, 2008, A perspective on intelligent devices and environments in medical rehabilitation, Med Eng Phys. source

      Not checked in the free run.

    • cites [256] Robert, 2013, Recommendations for ICT use in Alzheimer's disease assessment: Monaco CTAD expert meeting, J Nutr Health Aging source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Psychological models suggest that massage can help people with dementia retain a sense of meaningful and reassuring communication even when words fail and may help activate memories.

    “On the other hand, psychological models suggest that massage can help people with dementia to retain a sense of meaningful and reassuring communication even when words fail and may help to activate memories (252).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [252] Bush, 2011, The use of human touch to improve the well-being of older adults: a holistic nursing intervention, J Holistic Nurs. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A core feature of agitation is excessive motor activity; accelerometers can objectively measure abnormal motor activity, speech analyses may assess verbal aggression, and automated video analysis and activity recognition techniques can detect activities and movement sequences that underlie physical aggression.

    “A core feature of agitation is excessive motor activity, and accelerometers can objectively measure abnormal motor activity, speech analyses may assess verbal aggression, and automated video analysis and activity recognition techniques can detect activities and movement sequences that underline physical aggression (288).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [288] Cummings, 2015, Agitation in cognitive disorders: international psychogeriatric association provisional consensus clinical and research definition, Int Psychogeriatr. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    A recent descriptive review showed that a significant portion of current intelligent assistive technology is designed in the absence of explicit ethical considerations, and this may represent a structural limitation in the translation from designing labs to bedside.

    “A recent descriptive review showed that a significant portion of current intelligent assistive technology is designed in the absence of explicit ethical considerations, and this may represent a structural limitation in the translation from designing labs to bedside (275).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [275] Ienca, 2017, Ethical design of intelligent assistive technologies for dementia: a descriptive review, Sci Eng Ethics source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Serious games are widely recognized as promising non-pharmacological tools to assess patient's cognition and function, and to treat, stimulate, and improve patient's well-being.

    “SG are widely recognized as promising non-pharmacological tools to assess patient's cognition and function (340, 341), and to treat, stimulate, and improve patient's well-being (342).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [340] Zucchella, 2014, Serious games for screening pre-dementia conditions: from virtuality to reality? A pilot project, Funct Neurol.

      Not checked in the free run.

    • cites [341] Manera, 2015, ‘Kitchen and cooking,' a serious game for mild cognitive impairment and Alzheimer's disease: a pilot study, Front Aging Neurosci. source

      Not checked in the free run.

    • cites [342] Robert, 2014, Recommendations for the use of serious games in people with Alzheimer's Disease, related disorders and frailty, Front Aging Neurosci. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    With the availability of inexpensive low-power sensors, radios, and embedded processors, smart homes may be equipped with large amounts of networked sensors, which collaboratively process and make deductions from the acquired data on the state of the home, and the activity and behavior of its residents.

    “With the availability of inexpensive low-power sensors, radios, and embedded processors, smart homes may be equipped with large amounts of networked sensors, which collaboratively process and make deductions from the acquired data on the state of the home, and the activity and behavior of its residents (305–310).”
    Quote in the paperSubstantial claim0 of 6 sources checked
    • cites [305] Demiris, 2008, Technologies for an aging society: a systematic review of “smart home” applications, Yearb Med Inform.

      Not checked in the free run.

    • cites [306] Gentry, 2009, Smart homes for people with neurological disability: state of the art, NeuroRehabilitation source

      Not checked in the free run.

    • cites [307] Aiello, 2011, Smart homes to improve the quality of life for all, Conf Proc IEEE Eng Med Biol Soc. source

      Not checked in the free run.

    • cites [308] Ding, 2011, Sensor technology for smart homes, Maturitas source

      Not checked in the free run.

    • cites [309] Frisardi, 2011, Gerontechnology for demented patients: smart homes for smart aging, J Alzheimers Dis. source

      Not checked in the free run.

    • cites [310] Blasco, 2014, A smart kitchen for ambient assisted living, Sensors source

      Not checked in the free run.

    • Rests on an assumption: One of the key-supporting features of a smart home is the ability to monitor the ADL and safety of people, and to detect changes in their daily routines.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    A recent literature review concluded that game-based interventions can positively affect both physical health by improving balance, gait and voluntary motor control and cognitive function by enhancing attention, memory, and visuo-spatial abilities in older adults and in patients with dementia.

    “A recent literature review concluded that game-based interventions can positively affect both physical health by improving balance, gait and voluntary motor control and cognitive function by enhancing attention, memory, and visuo-spatial abilities in older adults and in patients with dementia (349).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [349] McCallum, Dementia Games: a literature review of dementia-related Serious Games

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The data on domotics are encouraging but some factors, such as the accessibility and affordability of these devices and the limited caregiver's awareness of their availability and utility, may prevent a more widespread use of these technologies.

    “The data on domotics are encouraging but some factors, e.g., the accessibility and affordability of these devices and the limited caregiver's awareness of their availability and utility, may prevent a more widespread use of these technologies (312).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [312] Bossen, 2015, Emerging roles for telemedicine and smart technologies in dementia care, Smart Homecare Technol Telehealth source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    ICT applications are rapidly expanding to support assistive and clinical tasks in people with dementia, but structural limitations to successful adoption include partial lack of clinical validation and insufficient focus on patient's needs.

    “In conclusion, ICT applications are rapidly expanding to support assistive and clinical tasks in people with dementia, but structural limitations to successful adoption include partial lack of clinical validation and insufficient focus on patient's needs.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Since most of the evidence on the role of VR comes from single case reports or restricted samples, the debate on its role in patients with dementia is still open.

    “Since most of the evidence on the role of VR come from single case reports or to restricted samples, the debate on its role in patients with dementia is still open.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Smart home technology seems to be a promising and cost-effective way of improving home care for people with dementia in a non-obtrusive way, allowing greater independence, maintaining good health, preventing social isolation, and relieving the workload from family caregivers and health providers.

    “Therefore, the smart home technology seems to be a promising and cost-effective way of improving home care for people with dementia in a non-obtrusive way, allowing greater independence, maintaining good health, preventing social isolation, and relieving the workload from family caregivers and health providers (311).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [311] Chan, 2009, Smart homes - current features and future perspectives, Maturitas source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Changes to home environment may result in lack of familiarity for the patient, and earlier home modifications might enable individuals with dementia to adjust to their adapted environment.

    “Changes to home environment may result in lack of familiarity for the patient, and earlier home modifications might enable individuals with dementia to adjust to their adapted environment (303).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [303] Allen, 2017, How people with dementia and their carers adapt their homes, Dementia source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Boosted by the publication of a Nature letter showing that video game training can enhance cognitive control in older adults, serious games specifically adapted to people with AD have been developed and employed to train physical and cognitive abilities, showing preliminary but encouraging results.

    “Boosted by the publication of a Nature letter showing that video game training can enhance cognitive control in older adults (343), SG specifically adapted to people with AD have been developed and employed to train physical and cognitive abilities, showing preliminary but encouraging results (341, 344–348).”
    Quote in the paperNot a substantial claim0 of 7 sources checked
    • cites [343] Anguera, 2013, Video game training enhances cognitive control in older adults, Nature source

      Not checked in the free run.

    • cites [341] Manera, 2015, ‘Kitchen and cooking,' a serious game for mild cognitive impairment and Alzheimer's disease: a pilot study, Front Aging Neurosci. source

      Not checked in the free run.

    • cites [344] Nouchi, 2012, Brain training game improves executive functions and processing speed in the elderly: a randomized controlled trial, PLoS ONE source

      Not checked in the free run.

    • cites [345] Oei, 2013, Enhancing cognition with video games: a multiple game training study, PLoS ONE source

      Not checked in the free run.

    • cites [346] Powers, 2013, Effects of video-game play on information processing: a meta-analytic investigation, Psychon Bull Rev. source

      Not checked in the free run.

    • cites [347] Bisoglio, 2014, Cognitive enhancement through action video game training: great expectations require greater evidence, Front Psychol. source

      Not checked in the free run.

    • cites [348] Ben-Sadoun, 2016, Physical and cognitive stimulation using an exergame in subjects with normal aging, mild and moderate cognitive impairment, J Alzheimers Dis. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Assistive technologies may help to support decision-making in vocational and personal health domains, to read, or use the telephone.

    “Moreover, assistive technologies may help to support decision-making in vocational and personal health domains (295), to read (296), or use the telephone (297).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [295] Stock, 2003, Self-directed career preference selection for individuals with intellectual disabilities: using computer technology to enhance self-determination, J Vocat Rehabil. source

      Not checked in the free run.

    • cites [296] Boman, 2012, The first step in designing a videophone for people with dementia: identification of users' potentials and the requirements of communication technology, Disabil Rehabil Assist Technol. source

      Not checked in the free run.

    • cites [297] Perilli, 2012, Persons with Alzheimer's disease make phone calls independently using a computer-aided telephone system, Res Dev Disabil. source

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    The advantages of VR compared to traditional assessment and training tools are naturalistic situations, safety from potential dangers that could occur in real-life situations, and enhancement of motivation because of its gaming, interactive, and immersive quality.

    “The advantages of VR in comparison to traditional assessment and training tools are represented by the naturalistic situations, the safety from potential dangers that could occur in real-life situations and the enhancement of motivation because of its gaming, interactive, and immersive quality.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A recent study proposed a novel AD screening test based on virtual environment and game principles to evaluate memory loss for common objects and recent events, and language changes.

    “A recent study proposed a novel AD screening tests based on virtual environment and game principles to evaluate memory loss for common objects and recent events, and language changes (339).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [339] Fernandez, 2017, Cognitive evaluation for the diagnosis of Alzheimer's disease based on turing test and virtual environments, Physiol Behav. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    External cueing systems can assist people with cognitive disabilities by reminding them to perform a task at the appropriate time or by providing guidance through a task.

    “For instance, external cueing systems can assist people with cognitive disabilities by reminding them to perform a task at the appropriate time (e.g., take their pills), or by providing guidance through a task (291–293), and sensors recording a patient's position in space may help in navigation through environment (294).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [291] Kime, 1996, Use of a comprehensive program of external cueing to enhance procedural memory in a patient with dense amnesia, Brain Inj. source

      Not checked in the free run.

    • cites [292] Mihailidis, 2001, The use of artificial intelligence in the design of an intelligent cognitive orthosis for people with dementia, Assist Technol. source

      Not checked in the free run.

    • cites [293] Hartin, 2014, Conf Proc IEEE Eng Med Biol Soc. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Telemedicine was found to be an independent predictor for increased treatment duration, likely because of the reduction of discomfort due to travel.

    “Moreover, likely because of the reduction of the discomfort due to travel, telemedicine was found to be an independent predictor for increased treatment duration (357).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [357] Cheong, 2015, The effect of telemedicine on the duration of treatment in dementia patients, J Telemed Telecare source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Clear evidence on the effectiveness of VR and SG for the assessment and training of people with AD requires further research that should adopt methodologies based upon best practices from clinical trials and incorporate behavioral and neurophysiological data.

    “On the basis of these preliminary data, clear evidence on the effectiveness of VR and SG for the assessment and training of people with AD requires further research that should adopt methodologies based upon best practices from clinical trials and incorporate behavioral and neurophysiological data.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    A systematic review on technology-driven telemedicine interventions for caregivers of persons with dementia concluded that included studies yielded positive findings in terms of mental health outcomes, but their marked heterogeneity impeded robust conclusions.

    “A systematic review on technology-driven telemedicine interventions, such as online training and support programs, for caregivers of persons with dementia concluded that included studies yielded positive findings in terms of mental health outcomes, but their marked heterogeneity impeded robust conclusions (368).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [368] Egan, 2018, Online training and support programs designed to improve mental health and reduce burden among caregivers of people with dementia: a systematic review, JAMDA source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Telemedicine can provide follow-up care to help people with dementia maintain their independence and continue living in their own homes, improve their safety, ameliorate clinical outcomes, and reduce access to health services.

    “Indeed, telemedicine can provide follow-up care to help people with dementia to maintain their independence and continue living in their own homes, improve their safety, (353, 354), ameliorate clinical outcomes, and reduce access to health services (355, 356).”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [353] Barton, 2011, Video-telemedicine in a memory disorders clinic: evaluation and management of rural elders with cognitive impairment, Telemed J E Health source

      Not checked in the free run.

    • cites [354] Brims, 2018, Effectiveness of assistive technology in improving the safety of people with dementia: a systematic review and meta-analysis, Aging Ment Health source

      Not checked in the free run.

    • cites [355] Barlow, 2007, A systematic review of the benefits of home telecare for frail elderly people and those with long-term conditions, J Telemed Telecare source

      Not checked in the free run.

    • cites [356] Botsis, 2008, Current status and future perspectives in telecare for elderly people suffering from chronic diseases, J Telemed Telecare source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Several studies confirmed the feasibility to perform cognitive assessment via telemedicine in elderly subjects with dementia and showed a good agreement with conventional face-to-face testing, and a high level of user satisfaction.

    “Several studies confirmed the feasibility to perform cognitive assessment via telemedicine in elderly subjects with dementia and showed a good agreement with conventional face-to-face testing, and a high level of user satisfaction (359–362).”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [359] Mair, 2000, Systematic review of studies of patient satisfaction with telemedicine, BMJ source

      Not checked in the free run.

    • cites [360] Currell, 2000, Telemedicine versus face to face patient care: effects on professional practice and health care outcomes, Cochrane Database Syst Rev. source

      Not checked in the free run.

    • cites [361] Asghar, 2018, Usability evaluation of assistive technologies through qualitative research focusing on people with mild dementia, Computers Human Behav. source

      Not checked in the free run.

    • cites [362] Brearly, 2017, Neuropsychological test administration by videoconference: a systematic review and meta-analysis, Neuropsychol Rev. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    A study comparing 15 databases for RCTs on CAM showed low overlap between databases and indicated that comprehensive CAM literature searches will require multiple databases.

    “A study comparing 15 databases for RCTs on CAM showed low overlap between databases and indicated that comprehensive CAM literature searches will require multiple databases (371) but this appear a minor problem in the present review because of the overall low quality of studies on CAM interventions.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [371] Cogo, 2011, Searching for controlled trials of complementary and alternative medicine: a comparison of 15 databases, Evid Based Complement Alternat Med. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Evidence-grading systems are biased toward RCTs, and they may lead to understatement of findings from non-RCT studies.

    “Evidence-grading systems are biased toward RCTs, and they may lead to understatement of findings from non-RCT studies (372).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [372] Frieden, 2017, Evidence for health decision making - beyond randomized, controlled trials, N Engl J Med. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A recent study conducted in a Southern California community showed that telemedicine was able to improve access and quality of dementia care, and most patients preferred the telemedicine consult compared to the traditional one.

    “A recent study conducted in a Southern California community showed not only that telemedicine was able to improve access and quality of dementia care, but also that most of the patients preferred the telemedicine consult compared to the traditional one (358).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [358] Tso, 2016, A multidisciplinary model of dementia care in an underserved retirement community, made possible by telemedicine, Front Neurol. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Both physical and cognitive games seem to have a positive impact on social and emotional function, improving mood and increasing positive affect and sociability.

    “Both physical and cognitive games seem to have a positive impact on social and emotional function, improving mood and increasing positive affect and sociability (350).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [350] Narme, 2016, Benefits of game-based leisure activities in normal aging and dementia, Geriatr Psychol Neuropsychiatr Vieil. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Some non-pharmacological interventions share methodological problems including small number of high-quality studies or double-blind RCTs, small sample sizes, heterogeneity in study design, type of intervention and outcomes, and uncertainty about the clinical significance of outcomes.

    “Some of them share methodological problems that are common to all non-pharmacological studies, which are typically practice-oriented. They include small number of high-quality studies or double-blind RCTs, small sample sizes, heterogeneity in terms of study design, type of intervention and outcomes, uncertainty about the clinical significance of outcomes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    Establishing systems for the care of dementia patients and their caregivers using telemedicine technologies seems to be feasible, but the evidence on clinical benefits is still scarce, cost-effectiveness data are lacking, and there is very little evidence of widespread practical applications.

    “Overall, establishing systems for the care of dementia patients and their caregivers using telemedicine technologies seems to be feasible, but the evidence on clinical benefits is still scarce, cost-effectiveness data are lacking, and there is very little evidence of widespread practical applications (369).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [369] Godwin, 2013, Technology-driven interventions for caregivers of persons with dementia: a systematic review, Am J Alzheimers Dis Other Demen. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Telephone-based support groups are a promising way to provide support for caregivers, but research is only at the beginning.

    “Telephone-based support groups is a promising way to provide support for caregivers, but research is only at the beginning (367).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [367] Berwig, 2017, Feasibility and effectiveness of a telephone - based social support intervention for informal caregivers of people with dementia: study protocol of the TALKING TIME project, BMC Health Services Res. source

      Not checked in the free run.

97 of 97

  • The paper relies on this without support.

    The majority of studies on non-pharmacological treatments for behavioral and psychological symptoms of dementia have been performed in nursing homes on patients with advanced dementia.

    “Most studies have been performed in nursing homes on patients with advanced dementia.”

  • The paper relies on this without support.

    The caregiver is often the only figure that manages patients' behavioral and psychological symptoms of dementia at home.

    “In contrast, as caregiver is often the only figure that manage patients' BPSD at home, future studies should address the role of NPT for BPSD in non-institutionalized people with dementia (106).”

  • The authors state this as an assumption.

    Combining different approaches may be the most suitable intervention to improve different outcomes in AD.

    “The proposal of multidimensional protocols of treatment is based on the hypothesis that combining different approaches may be the most suitable intervention to improve different outcomes in AD.”

  • The paper relies on this without support.

    Moving freely outdoors is an important ADL outcome associated with the ability to maintain independence and participation.

    “Moving freely outdoors is considered an important ADL outcome associated with the ability to maintain independence and participation.”

  • The paper relies on this without support.

    Dementia is a chronic disease with issues related to continuous long-term care and limited accessibility to medical service.

    “Since dementia is a chronic disease, with issues related to continuous long-term care and limited accessibility to medical service, telemedicine could be a valuable mean to provide assessment and care to dementia patients at home (352).”

  • The paper relies on this without support.

    Appropriate management of patients with AD and dementia is a significant public health concern, given the limited effectiveness of pharmacological therapies combined with their potentially life-threatening side effects.

    “Appropriate management of patients with AD and dementia is a significant public health concern, given the limited effectiveness of pharmacological therapies combined with their potentially life-threatening side effects.”

  • The paper relies on this without support.

    The direct transposition of the traditional methods of drug RCTs to the rehabilitation and NPT scenarios raises some issues.

    “The direct transposition of the traditional methods of drug RCTs to the rehabilitation and NPT scenarios raises some issues, and innovative trial designs would be helpful in these settings.”

  • The paper relies on this without support.

    One of the key-supporting features of a smart home is the ability to monitor the ADL and safety of people, and to detect changes in their daily routines.

    “One of the key-supporting features of a smart home is the ability to monitor the ADL and safety of people, and to detect changes in their daily routines.”

  • The paper relies on this without support.

    Patients with dementia can enjoy music, and their ability to respond to music is potentially preserved even in the late to severe stages of disease when verbal communication may have ceased.

    “A growing amount of evidence shows that patients with dementia can enjoy music, and their ability to respond to music is potentially preserved, even in the late to severe stages of disease when verbal communication may have ceased.”
9 of 9

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • CT is defined two different ways

    Minor

    The main text defines CT as cognitive training, but the table note defines CT as cognitive stimulation, which the paper abbreviates CS.

  • Table says art therapy has no RCTs despite citing one

    Minor

    Table 1 lists "No RCTs" as a limitation of art therapy, but the paper's references include a randomized controlled trial of art therapy for people with dementia.

2 of 2

Cites

Flagged first, then by citations

8 of the 385 references couldn’t be matched to a known paper.

Research works printed but not linked: 10

  1. World, The Global Impact of Dementia. An Analysis of Prevalence, Incidence, Cost and Trends
  2. World, 2006, Chronic Disease Information Sheets: Physical Activity
  3. NHS, 2011, An Economic Evaluation of Alternatives to Antipsychotic Drugs for Individuals Living With Dementia
  4. Gitlin, 2010, Improving Quality of Life in Individuals With Dementia: The Role of Nonpharmacologic Approaches in Rehabilitation, 22
  5. O'Neil, 2011, A Systematic Evidence Review of Non-pharmacological Interventions for Behavioural Symptoms of Dementia
  6. Gitlin, 2009, The Tailored Activity Program (TAP): a nonpharmacologic approach to improving quality of life at home for persons with dementia and their family caregivers, Gerontol Practice Concepts, 49, 428
  7. National, 2007, Dementia. A NICE-SCIE Guideline on Supporting People with Dementia and their Carers in Health and Social Care. National Clinical Practice Guideline, Number 42
  8. Dröes, 2011, An evaluation of the Meeting Centres Support Programme among persons with dementia and their carers, Nonpharmacol Therapies Dementia, 2, 19
  9. Forrester, 2014, Aromatherapy for dementia, Cochr Datab Syst Rev., 2, CD003150
  10. Nelson, 2004, The power of human touch in Alzheimer's care, Massage Ther J., 43, 82

Cited by

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Related

Authors
Zucchella, C., Sinforiani, E., Tamburin, S., Federico, A., Mantovani, E., Bernini, S., Casale, R., & Bartolo, M.
Affiliations
  • University of Verona (IT)
  • Fondazione Istituto Neurologico Nazionale Casimiro Mondino (IT)
Corresponding author
  • Tamburin, Stefano
  • Bartolo, Michelangelo
ORCID
Venue
Frontiers in Neurology
Publisher
Frontiers Media SA
Published
2018-12-13
Volume
9
Pages
1058-1058
ISSN
1664-2295 (ISSN-L)
DOI
10.3389/fneur.2018.01058
PMC
PMC6300511
OpenAlex
W2903800102
Semantic Scholar
eb9fa21a46adcb37d11c71a4b029ef159d1e0b7c
Cited by
297
References
385
Citations by year
2026: 24 · 2025: 32 · 2024: 39 · 2023: 53 · 2022: 60 · 2021: 37 · 2020: 38 · 2019: 12 · 2016: 2
FWCI
3.31
Type
journal article
Language
en
Open access
Licence
Locations
  • Frontiers in Neurology (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Cognitive Functions and Memory
Keywords
Alzheimer's disease, dementia, non-pharmacological treatment, multidisciplinary care, cognitive rehabilitation, behavioral and psychological symptoms of dementia, occupational therapy, psychotherapy, complementary and alternative medicine, virtual reality, telemedicine, assistive technology, home automation, caregiver burden, population aging

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.

Statistics and arithmetic are recomputed, not judged.

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