Systematic review of systematic reviews of non-pharmacological interventions to treat behavioural disturbances in older patients with dementia. The SENATOR-OnTop series.

During the course of their illness, many people with dementia develop behavioural and psychological symptoms of dementia (BPSD) including agitation, delusions, hallucinations and depression. Both pharmacological and non-pharmacological therapies have been developed as options for responding to BPSD. The former however are problematic and adverse side effects are common and although the latter are considered to be a preferable option, there is conflicting evidence on their efficacy and practicality. This paper by Abraha et al. (2017) assesses the evidence supporting non-pharmacological interventions, by updating a previous systematic review from 2011, with the aim of providing a working compendium for the non-drug management of dementia, as part of the Optimal Evidence-Based Non-Drug Therapies in Older People project. Some 38 reviews were included, from which 142 primary studies were identified providing details on non-pharmacological interventions for BPSD. The interventions were classified into sensory stimulation interventions of which there were nine different types, e.g. massage therapy and light therapy, cognitive/emotion-oriented interventions of which there were four different types e.g. cognitive stimulation therapy and validation therapy, behavioural management techniques, multi-component interventions and other interventions including exercise therapy and animal-assisted therapy. Under each classification, the evidence for each type of intervention was reviewed. Among sensory simulation interventions, music therapy was found to the only convincingly effective intervention for reducing behavioural symptoms. Some behavioural management techniques were also found to be promising. However, the authors conclude that overall there is limited evidence supporting the efficacy of non-pharmacological interventions due to the sample size, methodological quality and variations of interventions and outcomes assessed.
Title: 
Systematic review of systematic reviews of non-pharmacological interventions to treat behavioural disturbances in older patients with dementia. The SENATOR-OnTop series.
Journal: 
Date: 
2017
Theme or key words: 
References: 
Abraha, I., Rimland, J.M., Trotta, F.M., Dell’Aquila, G., Cruz-Jentoft, A., Petrovic, M., Gudmundsson, A., Soiza, R., O’Mahony, D., Guaita, A. and Cherubini, A. (2017) Systematic review of systematic reviews of non-pharmacological interventions to treat behavioural disturbances in older patients with dementia. The SENATOR-OnTop series, BMJ Open, e012759. doi:10.1136/bmjopen-2016012759.