Comparative safety and efficacy of pharmacological and non-pharmacological interventions for the behavioral and psychological symptoms of dementia: protocol for a systematic review and network meta-analysis

Background: Dementia is a global health concern, causing serious health and socioeconomic burdens with population aging. The associated symptoms of dementia, called behavioral and psychological symptoms of dementia (BPSD), are factors contributing to the socioeconomic burden of dementia. Recently, herbal medicine (HM) has attracted attention as a potential complementary therapy for BPSD. Therefore, this systematic review was aimed at analyzing the effectiveness (or efficacy), safety, and research status of HM in BPSD management through a comprehensive review.Methods: Thirteen electronic databases were searched comprehensively. Related clinical studies published until December 28, 2020, were collected. The methodological quality was evaluated using tools such as the Cochrane Collaboration’s risk of bias tool according to the study design. The effectiveness (or efficacy) was analyzed for randomized controlled trials (RCTs) only, and when sufficient homogeneity was assured, effect estimates were presented as mean difference (MD) and risk ratio (RR), with 95% confidence interval (CIs), through a meta-analysis.Results: A total of 52 clinical studies, including 36 RCTs, were included in this review. As an adjunctive therapy, HM showed statistically significant benefits in BPSD severity assessed by the Behavior Pathology in Alzheimer’s Disease Rating Scale (combined with psychotropic drugs: MD = −3.48, 95% CI: −3.96 to −2.99; with anti-dementia drugs: MD = −2.81, 95% CI: −3.17 to −2.45) and Neuropsychiatric Inventory (with anti-dementia drugs: MD = −3.23, 95% CI: −4.06 to −2.40). Adverse events were significantly less frequent in the HM group (RR = 0.50; 95% CI: 0.28 to 0.88). However, the methodological quality of the RCTs included in this systematic review was not optimal overall.Conclusion: According to the findings of this review, HM may be associated with additional benefits in BPSD treatment, particularly when used as an adjunct to conventional medications, including psychotropic and anti-dementia drugs. However, considering the methodological quality of the included RCTs, this clinical evidence is not robust. Nevertheless, dementia is a global health concern, and considering the limitations of conventional psychotropic drugs for BPSD, a major cause of the disease burden, HM appears to be a promising complementary therapy that warrants further research.

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Exercise training for managing behavioral and psychological symptoms in people with dementia: A systematic review and meta-analysis

Ageing Research Reviews ◽

10.1016/j.arr.2015.09.001 ◽

2015 ◽

Vol 24 ◽

pp. 274-285 ◽

Cited By ~ 50

Author(s):

Philipe de Souto Barreto ◽

Laurent Demougeot ◽

Fabien Pillard ◽

Maryse Lapeyre-Mestre ◽

Yves Rolland

Keyword(s):

Systematic Review ◽

Exercise Training ◽

Psychological Symptoms ◽

Meta Analysis ◽

People With Dementia ◽

Behavioral And Psychological Symptoms

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A systematic review of the relationship between behavioral and psychological symptoms (BPSD) and caregiver well-being

International Psychogeriatrics ◽

10.1017/s1041610216000922 ◽

2016 ◽

Vol 28 (11) ◽

pp. 1761-1774 ◽

Cited By ~ 78

Author(s):

Alexandra Feast ◽

Esme Moniz-Cook ◽

Charlotte Stoner ◽

Georgina Charlesworth ◽

Martin Orrell

Keyword(s):

Systematic Review ◽

Motor Behavior ◽

Psychological Symptoms ◽

Meta Analysis ◽

Well Being ◽

Future Research ◽

The Individual ◽

The Impact ◽

Behavioral And Psychological Symptoms

ABSTRACTBackground:Behavioral and psychological symptoms in dementia (BPSD) are important predictors of institutionalization as well as caregiver burden and depression. Previous reviews have tended to group BPSD as one category with little focus on the role of the individual symptoms. This review investigates the role of the individual symptoms of BPSD in relation to the impact on different measures of family caregiver well-being.Methods:Systematic review and meta-analysis of papers published in English between 1980 and December 2015 reporting which BPSD affect caregiver well-being. Paper quality was appraised using the Downs and Black Checklist (1998).Results:Forty medium and high quality quantitative papers met the inclusion criteria, 16 were suitable to be included in a meta-analysis of mean distress scores. Depressive behaviors were the most distressing for caregivers followed by agitation/aggression and apathy. Euphoria was the least distressing. Correlation coefficients between mean total behavior scores and mean distress scores were pooled for four studies. Irritability, aberrant motor behavior and delusions were the most strongly correlated to distress, disinhibition was the least correlated.Conclusions:The evidence is not conclusive as to whether some BPSD impact caregiver well-being more than others. Studies which validly examined BPSD individually were limited, and the included studies used numerous measures of BPSD and numerous measures of caregiver well-being. Future research may benefit from a consistent measure of BPSD, examining BPSD individually, and by examining the causal mechanisms by which BPSD impact well-being by including caregiver variables so that interventions can be designed to target BPSD more effectively.

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Implementation of evidence-based, non-pharmacological interventions addressing behavior and psychological symptoms of dementia: a systematic review focused on implementation strategies

International Psychogeriatrics ◽

10.1017/s1041610220001702 ◽

2020 ◽

pp. 1-29

Author(s):

Sally Bennett ◽

Kate Laver ◽

Margaret MacAndrew ◽

Elizabeth Beattie ◽

Lindy Clemson ◽

...

Keyword(s):

Systematic Review ◽

Quantitative Methods ◽

Psychological Symptoms ◽

Implementation Strategies ◽

Practice Change ◽

Evidence Based ◽

Pharmacological Interventions ◽

People With Dementia ◽

Implementation Studies ◽

Behavioral And Psychological Symptoms

ABSTRACT Objective This study aimed to identify the nature and effects of implementation strategies to increase the use of evidence-based, non-pharmacological interventions designed to reduce the frequency and/or severity of behavioral and psychological symptoms associated with dementia, for people living in the community. Design This was a systematic review of implementation studies. We searched six databases (in January 2019) and hand-searched reference lists of reports. Studies were included if they used quantitative methods evaluating the use of implementation strategies to increase the use of non-pharmacological interventions. These interventions had to have been tested in a randomized controlled trial (RCT) and found to reduce behavioral and psychological symptoms of dementia, for those living in the community. Studies needed to report the effect of the implementation on clinical practice, for example, a change in practice or the adoption of the intervention in community settings. Results Twelve studies were included: 11 one-group pre-post design studies and 1 cluster RCT. All studies reported practice change – the majority implementing a new intervention, with six different types of interventions implemented. All studies reported including using partnerships, new funding, educational strategies, and ongoing support and consultation. Seven implementation studies reported positive outcomes for clients on some aspect of behavior or depression for the person with dementia. Conclusions Implementation studies using multiple implementation strategies to increase the use of non-pharmacological interventions have demonstrated improvements in behavioral and psychological symptoms common in people with dementia, when provided by clinicians as part of their everyday work routines.

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Comparative safety and efficacy of statins for primary prevention in human immunodeficiency virus-positive patients: a systematic review and meta-analysis

European Heart Journal ◽

10.1093/eurheartj/ehv734 ◽

2016 ◽

Vol 37 (48) ◽

pp. 3600-3609 ◽

Cited By ~ 26

Author(s):

Sebastiano Gili ◽

Walter Grosso Marra ◽

Fabrizio D'Ascenzo ◽

Enrica Lonni ◽

Andrea Calcagno ◽

...

Keyword(s):

Systematic Review ◽

Human Immunodeficiency Virus ◽

Primary Prevention ◽

Meta Analysis ◽

Safety And Efficacy ◽

Immunodeficiency Virus ◽

Comparative Safety

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A Systematic Review and Meta-Analysis Comparing Carer Focused and Dyadic Multicomponent Interventions for Carers of People With Dementia

Journal of Aging and Health ◽

10.1177/0898264316660414 ◽

2016 ◽

Vol 29 (8) ◽

pp. 1308-1349 ◽

Cited By ~ 39

Author(s):

Kate Laver ◽

Rachel Milte ◽

Suzanne Dyer ◽

Maria Crotty

Keyword(s):

Systematic Review ◽

Psychological Symptoms ◽

Meta Analysis ◽

Randomized Controlled ◽

People With Dementia ◽

Significant Difference ◽

Person With Dementia ◽

Multicomponent Interventions ◽

Behavioral And Psychological Symptoms

Objective: The aim of this study was to compare the efficacy of two approaches: multicomponent interventions that focus on working with the carer and dyadic interventions that work with both the carer and the person with dementia. Method: A systematic review involving a search of Medline, EMBASE, and PsycINFO in October 2015 was performed. Randomized controlled trials involving carers of people with dementia and comparing multicomponent interventions with usual care were included. Results: Pooling of all studies demonstrated that multicomponent interventions can reduce depressive symptoms, improve quality of life, reduce carer impact, and reduce behavioral and psychological symptoms of dementia as well as caregiver upset with these symptoms. We were unable to find a significant difference in the effects of dyadic interventions in comparison with carer focused interventions for these outcomes. Discussion: Although effect sizes associated with intervention are small, multicomponent interventions are relatively inexpensive to deliver, acceptable, and widely applicable.

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