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

In the paper

“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).”

What the sources say

• Not checked yetcites [5] Birks, 2006, Cholinesterase inhibitors for Alzheimer's disease, Cochrane Database Syst Rev. source
• Not checked yetcites [6] Birks, 2015, Rivastigmine for Alzheimer's disease, Cochrane Database Syst Rev. source
• Not checked yetcites [7] Wong, 2016, Pharmacotherapy for dementia: a practical approach to the use of cholinesterase inhibitors and memantine, Drugs Aging source

In the paper

“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).”

What the sources say

• Not checked yetcites [16] Lautenschlager, 2010, Physical activity and mild cognitive impairment and Alzheimer's disease, Curr Neurol Neurosci Rep. source
• Not checked yetcites [17] Yaffe, 2001, A prospective study of physical activity and cognitive decline in elderly women: women who walk, Arch Intern Med. source
• Not checked yetcites [18] Podewils, 2005, Physical activity, APOE genotype, and dementia risk: findings from the cardiovascular health cognition study, Am J Epidemiol. source
• Not checked yetcites [19] Barnes, 2008, Cognition in older women: the importance of daytime movement, J Am Geriatr Soc. source
• Not checked yetcites [20] Middleton, 2008, Changes in cognition and mortality in relation to exercise in late life: a population based study, PLoS ONE source
• Not checked yetcites [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
• Not checked yetcites [22] Hamer, 2018, Physical activity and trajectories in cognitive function: English longitudinal study of ageing, J Epidemiol Community Health source
• Not checked yetcites [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
• Not checked yetcites [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

In the paper

“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).”

What the sources say

• Not checked yetcites [9] World, 2001

In the paper

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

In the paper

“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).”

What the sources say

• Not checked yetcites [26] Bray, 2016, Exercise prescription to reverse frailty, Appl Physiol Nutr Metab. source
• Not checked yetcites [27] Santos-Lozano, 2016, Physical activity and Alzheimer disease: a protective association, Mayo Clin Proc. source
• Not checked yetcites [28] Schuch, 2016, Exercise for depression in older adults: a metaanalysis of randomized controlled trials adjusting for publication bias, Rev Bras Psiquiatr. source
• Not checked yetcites [29] Law, 2018, Moderate intensity physical activity associates with CSF biomarkers in a cohort at risk for Alzheimer's disease, Alzheimers Dement. source
• Not checked yetcites [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
• Not checked yetcites [31] Northey, 2018, Exercise interventions for cognitive function in adults older than 50: a systematic review with metaanalysis, Br J Sports Med. source

In the paper

“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).”

What the sources say

• Not checked yetcites [10] Poulos, 2017, A comprehensive approach to reablement in dementia, Alzheimers Dement. source

In the paper

“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).”

What the sources say

• Not checked yetcites [41] Colcombe, 2004, Cardiovascular fitness, cortical plasticity, and aging, Proc Natl Acad Sci USA. source
• Not checked yetcites [42] Fleg, 2012, Aerobic exercise in the elderly: a key to successful aging, Discov Med.
• Not checked yetcites [43] Covas, 2002, Relationship between physical activity and oxidative stress biomarkers in women, Med Sci Sports Exerc. source
• Not checked yetcites [44] Lavie, 2011, Impact of physical activity, cardiorespiratory fitness, and exercise training on markers of inflammation, J Cardiopulm Rehabil Prev. source
• Not checked yetcites [45] Ghisi, 2010, Physical exercise and endothelial dysfunction, Arq Bras Cardiol. source
• Not checked yetcites [46] Churchill, 2002, Exercise, experience and the aging brain, Neurobiol Aging source
• Not checked yetcites [47] Davenport, 2012, Cerebrovascular reserve: the link between fitness and cognitive function?, Exerc Sport Sci Rev. source

In the paper

“The evidence on CT for people with dementia is less robust.”

In the paper

“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).”

What the sources say

• Not checked yetcites [56] Weinstein, 2012, The association between aerobic fitness and executive functions is mediated by prefrontal cortex volume, Brain Behav Immun. source
• Not checked yetcites [57] Niemann, 2014, Not only cardiovascular, but also coordinative exercise increases hippocampal volume in older adults, Front Aging Neurosci. source
• Not checked yetcites [58] Papenberg, 2016, Physical activity and inflammation: effects on gray-matter volume and cognitive decline in aging, Hum Brain Mapp. source

In the paper

“Exercise may also preserve neurons and promote neurogenesis, synaptogenesis, (48–50), and neuronal plasticity (51–55).”

What the sources say

• Not checked yetcites [48] Colcombe, 2003, Fitness effects on the cognitive function of older adults: a meta-analytic study, Psychol Sci. source
• Not checked yetcites [49] Kronenberg, 2006, Physical exercise prevents age-related decline in precursor cell activity in the mouse dentate gyrus, Neurobiol Aging source
• Not checked yetcites [50] Uda, 2006, Effects of chronic treadmill running on neurogenesis in the dentate gyrus of the hippocampus of adult rat, Brain Res. source
• Not checked yetcites [51] Cotman, 2002, Exercise: a behavioural intervention toenhance brain health and plasticity, Trends Neurosci. source
• Not checked yetcites [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
• Not checked yetcites [53] Cotman, 2007, Physical activity and the maintenance of cognition: learning from animal models, Alzheimers Dement source
• Not checked yetcites [54] Voelcker-Rehage, 2013, Structural and functional brain changes related to different types of physical activity across the life span, Neurosci Biobehav Rev. source
• Not checked yetcites [55] Hamaide, 2016, Neuroplasticity and MRI: a perfect match, Neuroimage source

In the paper

“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.”

In the paper

“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).”

What the sources say

• Not checked yetcites [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
• Not checked yetcites [61] Vaynman, 2004, Hippocampal BDNF mediates the efficacy of exercise on synaptic plasticity and cognition, Eur J Neurosci. source
• Not checked yetcites [62] Erickson, 2012, Physical activity, brain plasticity, and Alzheimer's disease, Arch Med Res. source
• Not checked yetcites [63] Intlekofer, 2013, Exercise counteracts declining hippocampal function in aging and Alzheimer's disease, Neurobiol Dis. source

In the paper

“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).”

What the sources say

• Not checked yetcites [77] Kallio, 2017, Cognitive training interventions for patients with Alzheimer's disease: a systematic review, J Alzheimers Dis. source

In the paper

“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.”

In the paper

“Most RCTs showed no effect of CT on other outcomes, but their low quality impede any solid conclusion (70–72, 74, 77).”

What the sources say

• Not checked yetcites [70] Olazarán, 2010, Nonpharmacological therapies in Alzheimer's disease: a systematic review of efficacy, Dement Geriatr Cogn Disord. source
• Not checked yetcites [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
• Not checked yetcites [72] Bahar-Fuchs, 2013, Cognitive training and cognitive rehabilitation for mild to moderate Alzheimer's disease and vascular dementia, Cochrane Database Syst Rev. source
• Not checked yetcites [74] Carrion, 2018, Cognitive Therapy for dementia patients: a systematic review, Dement Geriatr Cogn Disord. source
• Not checked yetcites [77] Kallio, 2017, Cognitive training interventions for patients with Alzheimer's disease: a systematic review, J Alzheimers Dis. source

In the paper

“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).”

What the sources say

• Not checked yetcites [92] Herrmann, 2006, The contribution of neuropsychiatric symptoms to the cost of dementia care, Int J Geriatr Psychiatry source

In the paper

“The small body of evidence for other sensory interventions, such as massage and touch therapy, suggests they could be viable treatment options, especially given the ease of implementation and minimal training involved.”

What the sources say

• Not checked yetcites [70] Olazarán, 2010, Nonpharmacological therapies in Alzheimer's disease: a systematic review of efficacy, Dement Geriatr Cogn Disord. source
• Not checked yetcites [99] O'Connor, 2009, Psychosocial treatments of behaviour symptoms in dementia: a systematic review of reports meeting quality standards, Int Psychogeriatr. source
• Not checked yetcites [103] O'Neil, 2011
• Not checked yetcites [104] Brodaty, 2012, Meta-analysis of nonpharmacological interventions for neuropsychiatric symptoms of dementia, Am J Psychiatry source
• Not checked yetcites [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 yetcites [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 yetcites [107] Abraha, 2017, Systematic review of systematic reviews of non-pharmacological interventions to treat behavioural disturbances in older patients with dementia, BMJ Open source

In the paper

“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”

What the sources say

• Not checked yetcites [89] Aalten, 2008, Consistency of neuropsychiatric syndromes across dementias: results from the European Alzheimer disease consortium, Dement Geriatr Cogn Disord. source
• Not checked yetcites [90] Kazui, 2016, Differences of behavioural and psychological symptoms of dementia in disease severity in four major dementias, PLoS ONE source

In the paper

“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.”

What the sources say

• Not checked yetcites [89] Aalten, 2008, Consistency of neuropsychiatric syndromes across dementias: results from the European Alzheimer disease consortium, Dement Geriatr Cogn Disord. source
• Not checked yetcites [90] Kazui, 2016, Differences of behavioural and psychological symptoms of dementia in disease severity in four major dementias, PLoS ONE source

In the paper

“In particular, there are no conclusive results for validation and reminiscence therapy, the effectiveness of light therapy is not clear, aromatherapy is better than no treatment.”

What the sources say

• Not checked yetcites [70] Olazarán, 2010, Nonpharmacological therapies in Alzheimer's disease: a systematic review of efficacy, Dement Geriatr Cogn Disord. source
• Not checked yetcites [99] O'Connor, 2009, Psychosocial treatments of behaviour symptoms in dementia: a systematic review of reports meeting quality standards, Int Psychogeriatr. source
• Not checked yetcites [103] O'Neil, 2011
• Not checked yetcites [104] Brodaty, 2012, Meta-analysis of nonpharmacological interventions for neuropsychiatric symptoms of dementia, Am J Psychiatry source
• Not checked yetcites [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 yetcites [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 yetcites [107] Abraha, 2017, Systematic review of systematic reviews of non-pharmacological interventions to treat behavioural disturbances in older patients with dementia, BMJ Open source

In the paper

“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.”

What the sources say

• Not checked yetcites [94] Sorbi, 2012, EFNS-ENS guidelines on the diagnosis and management of disorders associated with dementia, Eur J Neurol. source
• Not checked yetcites [95] Dyer, 2018, An overview of systematic reviews of pharmacological and non-pharmacological interventions for the treatment of behavioural and psychological symptoms of dementia, Int Psychogeriatr. source
• Not checked yetcites [96] Gauthier, 2010, Management of behavioral problems in Alzheimer's disease, Int Psychogeriatr source
• Not checked yetcites [97] Seitz, 2013, Pharmacological treatments for neuropsychiatric symptoms of dementia in long-term care: a systematic review, Int Psychogeriatr. source
• Not checked yetcites [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
• Not checked yetcites [99] O'Connor, 2009, Psychosocial treatments of behaviour symptoms in dementia: a systematic review of reports meeting quality standards, Int Psychogeriatr. source

In the paper

“Music therapy and behavioral management techniques seem to cause a short-term reduction of BPSD, but long-term efficacy is unclear.”

What the sources say

• Not checked yetcites [70] Olazarán, 2010, Nonpharmacological therapies in Alzheimer's disease: a systematic review of efficacy, Dement Geriatr Cogn Disord. source
• Not checked yetcites [99] O'Connor, 2009, Psychosocial treatments of behaviour symptoms in dementia: a systematic review of reports meeting quality standards, Int Psychogeriatr. source
• Not checked yetcites [103] O'Neil, 2011
• Not checked yetcites [104] Brodaty, 2012, Meta-analysis of nonpharmacological interventions for neuropsychiatric symptoms of dementia, Am J Psychiatry source
• Not checked yetcites [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 yetcites [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 yetcites [107] Abraha, 2017, Systematic review of systematic reviews of non-pharmacological interventions to treat behavioural disturbances in older patients with dementia, BMJ Open source

In the paper

“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).”

What the sources say

• Not checked yetcites [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

In the paper

“Potential benefits of these interventions have been documented, but the strength of evidence is overall low and the great heterogeneity in terms of type of intervention, follow-up duration, type of outcome measures hamper comparison across studies.”

What the sources say

• Not checked yetcites [70] Olazarán, 2010, Nonpharmacological therapies in Alzheimer's disease: a systematic review of efficacy, Dement Geriatr Cogn Disord. source
• Not checked yetcites [99] O'Connor, 2009, Psychosocial treatments of behaviour symptoms in dementia: a systematic review of reports meeting quality standards, Int Psychogeriatr. source
• Not checked yetcites [103] O'Neil, 2011
• Not checked yetcites [104] Brodaty, 2012, Meta-analysis of nonpharmacological interventions for neuropsychiatric symptoms of dementia, Am J Psychiatry source
• Not checked yetcites [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 yetcites [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 yetcites [107] Abraha, 2017, Systematic review of systematic reviews of non-pharmacological interventions to treat behavioural disturbances in older patients with dementia, BMJ Open source

In the paper

“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).”

What the sources say

• Not checked yetcites [84] Hall, 2013, Cognitive Stimulation Therapy (CST): neurpsychological mechanisms of change, Int Psychogeriatr. source

In the paper

“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.”

What the sources say

• Not checked yetcites [100] Gitlin, 2010

In the paper

“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.”

What the sources say

• Not checked yetcites [101] Norton, 1996, Need-driven dementia-compromised behavior: an alternative view of disruptive behavior, Am J Alzheimer's Dis Other Dem. source
• Not checked yetcites [102] Kovach, 2005, A model of consequences of need-driven, dementia-compromised behavior, J Nurs Scholarsh. source

In the paper

“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).”

What the sources say

• Not checked yetcites [108] Cohen-Mansfield, 2014, Predictors of the impact of nonpharmacologic interventions for agitation in nursing home residents with advanced dementia source

In the paper

“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”

What the sources say

• Not checked yetcites [163] Orgeta, 2014, Psychological treatments for depression and anxiety in dementia and mild cognitive impairment, Cochrane Database Syst Rev. source

In the paper

“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).”

What the sources say

• Not checked yetcites [155] Spalletta, 2015, Longitudinal neuropsychiatric predictors of death in Alzheimer's disease, J Alzheimers Dis. source
• Not checked yetcites [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 yetcites [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

In the paper

“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).”

What the sources say

• Not checked yetcites [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

In the paper

“OT seems also effective in reducing BPSD, increasing patient's participation, improving physical performance, and QoL and reducing negative communication (123–129).”

What the sources say

• Not checked yetcites [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 yetcites [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 yetcites [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 yetcites [126] Rao, 2014, Occupational therapy in chronic progressive disorders: enhancing function and modifying disease, Am J Occup Ther. source
• Not checked yetcites [127] Pimouguet, 2017, Benefits of occupational therapy in dementia patients: findings from a real-world observational study, J Alzheimers Dis. source
• Not checked yetcites [128] Gitlin, 2008, Tailored activities to manage neuropsychiatry behavior in persons with dementia and reduce caregiver burden, Am J Geriatr Psychiatry source
• Not checked yetcites [129] Gitlin, 2018, Targeting behavioral symptoms and functional decline in dementia: a randomized clinical trial, J Am Geriatr Soc. source

In the paper

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

In the paper

“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).”

What the sources say

• Not checked yetcites [144] Enache, 2011, Depression in dementia: epidemiology, mechanisms, and treatment, Curr Opin Psychiatry source
• Not checked yetcites [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 yetcites [146] Starkstein, 2005, The construct of minor and major depression in Alzheimer's disease, Am J Psychiatry source
• Not checked yetcites [147] Hwang, 2004, Mild cognitive impairment is associated with characteristic neuropsychiatric symptoms, Alzheimer Dis Assoc Disord. source

In the paper

“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).”

What the sources say

• Not checked yetcites [151] Rozzini, 2009, Int J Geriatr Psychiatry source

In the paper

“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.”

In the paper

“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).”

What the sources say

• Not checked yetcites [113] Muò, 2005, Alzheimer's disease-associated disability: an ICF approach, Disabil Rehabil. source
• Not checked yetcites [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 yetcites [115] Prizer, 2018, Progressive support for activities of daily living for persons living with dementia, Gerontologist source
• Not checked yetcites [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 yetcites [117] Egan, 2006, Dementia and occupation: a review of the literature, Can J Occupat Ther. source

In the paper

“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).”

What the sources say

• Not checked yetcites [148] Schultz, 2004, Anxiety and impaired social function in the elderly, Ann Clin Psychiatry source
• Not checked yetcites [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 yetcites [150] Lu, 2009, Donepezil delays progression to AD in MCI subjects with depressive symptoms, Neurology source

In the paper

“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).”

What the sources say

• Not checked yetcites [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 yetcites [166] Theleritis, 2018, A systematic review of non-pharmacological treatments for apathy in dementia, Int J Geriatr Psychiatry source

In the paper

“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).”

What the sources say

• Not checked yetcites [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 yetcites [112] Cohen-Mansfield, 2015, Which unmet needs contribute to behaviour problems in persons with advanced dementia?, Psychiatry Res. source

In the paper

“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).”

What the sources say

• Not checked yetcites [121] Graff, 2006, Community based occupational therapy for patients with dementia and their caregivers: randomised controlled trial, BMJ source

In the paper

“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).”

What the sources say

• Not checked yetcites [131] Padilla, 2011, Effectiveness of environment-based interventions for people with Alzheimer's disease and related dementias, Am J Occup Ther. source

In the paper

“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).”

What the sources say

• Not checked yetcites [164] Cheston, 2017, Int J Geriatr Psychiatry source

In the paper

“Besides being effective in reducing caregiver burden, in that caregiver had significantly more free time, TAP was demonstrated to be highly cost-effective (123).”

What the sources say

• Not checked yetcites [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

In the paper

“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.”

What the sources say

• Not checked yetcites [159] Doody, 2001, Practice parameter: management of dementia (an evidence-based review), Neurology source
• Not checked yetcites [160] Lyketsos, 2002, Depression in Alzheimer's disease: overview and treatment, Biol Psychiatry source
• Not checked yetcites [161] Douglas, 2004, Non-pharmacological interventions in dementia, Adv Psychiatr Treat source

In the paper

“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).”

What the sources say

• Not checked yetcites [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 yetcites [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 yetcites [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 yetcites [173] Dröes, 2011, An evaluation of the Meeting Centres Support Programme among persons with dementia and their carers, Nonpharmacol Therapies Dementia

In the paper

“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).”

What the sources say

• Not checked yetcites [191] Forrester, 2014, Aromatherapy for dementia, Cochrane Database Syst Rev. source

In the paper

“Actually, some systematic reviews demonstrated that multicomponent interventions were more effective than single activities in improving general well-being of both persons with dementia and their caregivers (70, 175), and in hospitalized older adults with cognitive impairment (176, 177).”

What the sources say

• Not checked yetcites [70] Olazarán, 2010, Nonpharmacological therapies in Alzheimer's disease: a systematic review of efficacy, Dement Geriatr Cogn Disord. source
• Not checked yetcites [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 yetcites [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 yetcites [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

In the paper

“From a psychological point of view, music facilitates communicative and relational processes and emotional expression (206).”

What the sources say

• Not checked yetcites [206] Gold, 2009, Dose-response relationship in music therapy for people with serious mental disorders; systematic review and meta-analysis, Clin Psychol Rev. source

In the paper

“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).”

What the sources say

• Not checked yetcites [193] Raglio, 2018, Music listening for people living with dementia, J Am Med Dir Assoc. source

In the paper

“Moreover, since music can stimulate both motor and cognitive functions, it can be an efficient tool for rehabilitation (207).”

What the sources say

• Not checked yetcites [207] Schlaug, 2009, Part VI introduction: listening to and making music facilitates brain recovery processes, Ann N Y Acad Sci. source

In the paper

“Indeed, aromatherapy has been used to address BPSD (181–186) and sleep disturbances (187–189) and to stimulate motivational behavior (190).”

What the sources say

• Not checked yetcites [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 yetcites [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 yetcites [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 yetcites [184] Nguyen, 2008, The use of aromatherapy to treat behavioural problems in dementia, Int J Geriatr Psychiatry source
• Not checked yetcites [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 yetcites [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 yetcites [187] Wolfe, 1996, Can aromatherapy oils promote sleep in severely demented patients?, Int J Geriatr Psychiatry source
• Not checked yetcites [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 yetcites [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 yetcites [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.

In the paper

“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).”

What the sources say

• Not checked yetcites [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 yetcites [245] Remington, 2002, Calming music and hand massage with agitated elderly, Nurs Res. source
• Not checked yetcites [246] Nelson, 2004, The power of human touch in Alzheimer's care, Massage Ther J.
• Not checked yetcites [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 yetcites [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 yetcites [249] Moyle, 2014, Foot massage and physiological stress in people with dementia: a randomized controlled trial, J Altern Complement Med. source
• Not checked yetcites [250] Kapoor, 2015, Effect of therapeutic massage on pain in patients with dementia, Dementia source

In the paper

“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).”

What the sources say

• Not checked yetcites [223] Baird, 2015, Music and dementia, Prog Brain Res. source
• Not checked yetcites [224] Samson, 2015, Efficacy of musical interventions in dementia: methodological requirements of non-pharmacological trials, Ann NY Acad Sci. source

In the paper

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

In the paper

“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).”

What the sources say

• Not checked yetcites [230] Sterritt, 1994, Art activities for patients with Alzheimer's and related disorders, Geriatr Nurs. source
• Not checked yetcites [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 yetcites [232] Bonner, 2006
• Not checked yetcites [233] Hannemann, 2006, Creativity with dementia patients, Gerontology source
• Not checked yetcites [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 yetcites [235] Flood, 2007, Creativity in older adults: a plethora of possibilities, Issues Ment Health Nurs. source
• Not checked yetcites [236] Schmitt, 2007, Creative therapy options for patients with dementia–a systematic review, Fortschr Neurol Psychiatr. source
• Not checked yetcites [237] Cummings, 2008, Creativity and dementia: emerging diagnostic and treatment methods for Alzheimer's disease, CNS Spectr.
• Not checked yetcites [238] Stoukides, 2008, Creative and sensory therapies enhance the lives of people with Alzheimers, Med Health R I.
• Not checked yetcites [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

In the paper

“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).”

What the sources say

• Not checked yetcites [230] Sterritt, 1994, Art activities for patients with Alzheimer's and related disorders, Geriatr Nurs. source
• Not checked yetcites [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 yetcites [232] Bonner, 2006
• Not checked yetcites [233] Hannemann, 2006, Creativity with dementia patients, Gerontology source
• Not checked yetcites [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 yetcites [235] Flood, 2007, Creativity in older adults: a plethora of possibilities, Issues Ment Health Nurs. source
• Not checked yetcites [236] Schmitt, 2007, Creative therapy options for patients with dementia–a systematic review, Fortschr Neurol Psychiatr. source
• Not checked yetcites [237] Cummings, 2008, Creativity and dementia: emerging diagnostic and treatment methods for Alzheimer's disease, CNS Spectr.
• Not checked yetcites [238] Stoukides, 2008, Creative and sensory therapies enhance the lives of people with Alzheimers, Med Health R I.
• Not checked yetcites [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

In the paper

“Whether art therapy can be useful and may represent an effective rehabilitative strategy for people suffering from dementia is a debated issue (228, 110).”

What the sources say

• Not checked yetcites [228] Chancellor, 2014, Art therapy for Alzheimer's disease and other dementias, J Alzheimers Dis. source
• Not checked yetcites [110] Scales, 2018, Evidence-based nonpharmacological practices to address behavioural and psychological symptoms of dementia, Gerontologist source

In the paper

“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).”

What the sources say

• Not checked yetcites [192] van, 2017, Cochrane Database Syst Rev. source

In the paper

“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).”

What the sources say

• Not checked yetcites [192] van, 2017, Cochrane Database Syst Rev. source

In the paper

“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.”

In the paper

“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).”

What the sources say

• Not checked yetcites [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

In the paper

“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).”

What the sources say

• Not checked yetcites [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

In the paper

“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).”

What the sources say

• Not checked yetcites [259] Pilotto, 2011, J Alzheimers Dis. source
• Not checked yetcites [262] Faucounau, 2009, Electronic tracking system and wandering in Alzheimer's disease: a case study, Ann Phys Rehabil Med. source
• Not checked yetcites [268] Robinson, 2007, Balancing rights and risks: conflicting perspectives in the management of wandering in dementia, Health Risk Soc. source
• Not checked yetcites [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

In the paper

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

What the sources say

• Not checked yetcites [289] Melander, 2017, Measuring electrodermal activity to improve the identification of agitation in individuals with dementia, Dement Geriatr Cogn Disord Extra source

In the paper

“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).”

What the sources say

• Not checked yetcites [270] Niemeijer, 2011, The ideal application of surveillance technology in residential care for people with dementia, J Med Ethics source
• Not checked yetcites [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 yetcites [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

In the paper

“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).”

What the sources say

• Not checked yetcites [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

In the paper

“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.”

In the paper

“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”

What the sources say

• Not checked yetcites [254] Culler, 2004, Guest editors' introduction: overview of sensor networks, Computer source
• Not checked yetcites [255] Cooper, 2008, A perspective on intelligent devices and environments in medical rehabilitation, Med Eng Phys. source
• Not checked yetcites [256] Robert, 2013, Recommendations for ICT use in Alzheimer's disease assessment: Monaco CTAD expert meeting, J Nutr Health Aging source

In the paper

“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).”

What the sources say

• Not checked yetcites [252] Bush, 2011, The use of human touch to improve the well-being of older adults: a holistic nursing intervention, J Holistic Nurs. source

In the paper

“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).”

What the sources say

• Not checked yetcites [288] Cummings, 2015, Agitation in cognitive disorders: international psychogeriatric association provisional consensus clinical and research definition, Int Psychogeriatr. source

In the paper

“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).”

What the sources say

• Not checked yetcites [275] Ienca, 2017, Ethical design of intelligent assistive technologies for dementia: a descriptive review, Sci Eng Ethics source

In the paper

“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).”

What the sources say

• Not checked yetcites [340] Zucchella, 2014, Serious games for screening pre-dementia conditions: from virtuality to reality? A pilot project, Funct Neurol.
• Not checked yetcites [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 yetcites [342] Robert, 2014, Recommendations for the use of serious games in people with Alzheimer's Disease, related disorders and frailty, Front Aging Neurosci. source

In the paper

“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).”

What the sources say

• Not checked yetcites [305] Demiris, 2008, Technologies for an aging society: a systematic review of “smart home” applications, Yearb Med Inform.
• Not checked yetcites [306] Gentry, 2009, Smart homes for people with neurological disability: state of the art, NeuroRehabilitation source
• Not checked yetcites [307] Aiello, 2011, Smart homes to improve the quality of life for all, Conf Proc IEEE Eng Med Biol Soc. source
• Not checked yetcites [308] Ding, 2011, Sensor technology for smart homes, Maturitas source
• Not checked yetcites [309] Frisardi, 2011, Gerontechnology for demented patients: smart homes for smart aging, J Alzheimers Dis. source
• Not checked yetcites [310] Blasco, 2014, A smart kitchen for ambient assisted living, Sensors source

In the paper

“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).”

What the sources say

• Not checked yetcites [349] McCallum, Dementia Games: a literature review of dementia-related Serious Games

In the paper

“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).”

What the sources say

• Not checked yetcites [312] Bossen, 2015, Emerging roles for telemedicine and smart technologies in dementia care, Smart Homecare Technol Telehealth source

In the paper

“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.”

In the paper

“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.”

In the paper

“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).”

What the sources say

• Not checked yetcites [311] Chan, 2009, Smart homes - current features and future perspectives, Maturitas source

In the paper

“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).”

What the sources say

• Not checked yetcites [303] Allen, 2017, How people with dementia and their carers adapt their homes, Dementia source

In the paper

“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).”

What the sources say

• Not checked yetcites [343] Anguera, 2013, Video game training enhances cognitive control in older adults, Nature source
• Not checked yetcites [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 yetcites [344] Nouchi, 2012, Brain training game improves executive functions and processing speed in the elderly: a randomized controlled trial, PLoS ONE source
• Not checked yetcites [345] Oei, 2013, Enhancing cognition with video games: a multiple game training study, PLoS ONE source
• Not checked yetcites [346] Powers, 2013, Effects of video-game play on information processing: a meta-analytic investigation, Psychon Bull Rev. source
• Not checked yetcites [347] Bisoglio, 2014, Cognitive enhancement through action video game training: great expectations require greater evidence, Front Psychol. source
• Not checked yetcites [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

In the paper

“Moreover, assistive technologies may help to support decision-making in vocational and personal health domains (295), to read (296), or use the telephone (297).”

What the sources say

• Not checked yetcites [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 yetcites [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 yetcites [297] Perilli, 2012, Persons with Alzheimer's disease make phone calls independently using a computer-aided telephone system, Res Dev Disabil. source

In the paper

“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.”

In the paper

“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).”

What the sources say

• Not checked yetcites [339] Fernandez, 2017, Cognitive evaluation for the diagnosis of Alzheimer's disease based on turing test and virtual environments, Physiol Behav. source

In the paper

“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).”

What the sources say

• Not checked yetcites [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 yetcites [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 yetcites [293] Hartin, 2014, Conf Proc IEEE Eng Med Biol Soc. source

In the paper

“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).”

What the sources say

• Not checked yetcites [357] Cheong, 2015, The effect of telemedicine on the duration of treatment in dementia patients, J Telemed Telecare source

In the paper

“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.”

In the paper

“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).”

What the sources say

• Not checked yetcites [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

In the paper

“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).”

What the sources say

• Not checked yetcites [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 yetcites [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 yetcites [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 yetcites [356] Botsis, 2008, Current status and future perspectives in telecare for elderly people suffering from chronic diseases, J Telemed Telecare source

In the paper

“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).”

What the sources say

• Not checked yetcites [359] Mair, 2000, Systematic review of studies of patient satisfaction with telemedicine, BMJ source
• Not checked yetcites [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 yetcites [361] Asghar, 2018, Usability evaluation of assistive technologies through qualitative research focusing on people with mild dementia, Computers Human Behav. source
• Not checked yetcites [362] Brearly, 2017, Neuropsychological test administration by videoconference: a systematic review and meta-analysis, Neuropsychol Rev. source

In the paper

“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.”

What the sources say

• Not checked yetcites [371] Cogo, 2011, Searching for controlled trials of complementary and alternative medicine: a comparison of 15 databases, Evid Based Complement Alternat Med. source

In the paper

“Evidence-grading systems are biased toward RCTs, and they may lead to understatement of findings from non-RCT studies (372).”

What the sources say

• Not checked yetcites [372] Frieden, 2017, Evidence for health decision making - beyond randomized, controlled trials, N Engl J Med. source

In the paper

“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).”

What the sources say

• Not checked yetcites [358] Tso, 2016, A multidisciplinary model of dementia care in an underserved retirement community, made possible by telemedicine, Front Neurol. source

In the paper

“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).”

What the sources say

• Not checked yetcites [350] Narme, 2016, Benefits of game-based leisure activities in normal aging and dementia, Geriatr Psychol Neuropsychiatr Vieil. source

In the paper

“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.”

In the paper

“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).”

What the sources say

• Not checked yetcites [369] Godwin, 2013, Technology-driven interventions for caregivers of persons with dementia: a systematic review, Am J Alzheimers Dis Other Demen. source

In the paper

“Telephone-based support groups is a promising way to provide support for caregivers, but research is only at the beginning (367).”

What the sources say

• Not checked yetcites [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