scholarly journals Non-pharmacological therapy in the management of behavioral and cognitive symptoms of dementia: a literature review

2021 ◽  
Author(s):  
Ana Catarini Lopes Baltazar ◽  
Amanda Mansur Rosa ◽  
Ana Luiza Soares Henriques de Almeida ◽  
Isabela Guedes ◽  
Luciana Maria Campos e Silva ◽  
...  
Keyword(s):  
Intervention Program ◽  
Psychological Symptoms ◽  
Behavioral Therapy ◽  
Pharmacological Therapy ◽  
Pharmacological Intervention ◽  
Pharmacological Treatments ◽  
Pharmacological Interventions ◽  
Pubmed Database ◽  
Alternative Approaches ◽  
Behavioral And Psychological Symptoms

Background: Pharmacological treatments for dementia, such as antipsychotics and benzodiazepines, cause significant side effects. Therefore, the search for non-pharmacological alternatives for relieving behavioral and psychological symptoms of dementia is increasing. Up to 90% of patients with dementia are affected by one or more symptoms: behavior change, disturbing vocalization, restlessness, rambling, apathy, among others. Objectives: Analyze the effectiveness of non-pharmacological measures in the management of dementia. Design and Setting: Review of the literature. Methods: The PubMed database was used with the descriptors “non pharmacological interventions”, and “dementia”. From the 450 found, 9 articles published between 2015 and 2019 were selected. Results: Some non-pharmacological measures reported were art therapy, music therapy, aromatherapy, behavioral therapy and physical exercises. However, intervention methods varied between studies as they used different teoric bases and investigated individually the effect of personalized activities. The best results were found when the treatment was adapted to the interests and skills of the participants, mainly regarding apathy and agitation. In addition, a study has shown that an organized non-pharmacological intervention program was also effective in controlling external and intrinsic symptoms, including hallucination and delirium. Conclusion: Studies focusing on alternative approaches reveal that different non-pharmacological interventions are able to reduce psychological symptoms and behavioral disorders. Therefore, they should be considered as first option interventions for treatment. In addition, these variants of precise treatment for greater visibility and more comprehensive studies.

scholarly journals Developing a virtual reality for people with dementia in nursing homes based on their psychological needs: a feasibility study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jung-Hee Kim ◽  
Seonmin Park ◽  
Hyeongji Lim
Keyword(s):  
Virtual Reality ◽  
Nursing Homes ◽  
Intervention Program ◽  
Psychological Symptoms ◽  
Likert Scale ◽  
Psychological Needs ◽  
Second Phase ◽  
People With Dementia ◽  
The Mean ◽  
Behavioral And Psychological Symptoms

Abstract Background The purpose of this study was (1) to develop a virtual reality (VR) intervention program based on the psychological needs of patients residing in nursing facilities in South Korea to alleviate their behavioral and psychological symptoms and (2) to confirm the possibility of utilizing VR in patients with dementia. Methods In the first phase, patients with dementia residing in nursing homes and experiencing behavioral and psychological symptoms were recruited. Surveys and questionnaires were used to identify activities that alleviated the behavioral and psychological symptoms of dementia (BPSD) among the patients. These activities were classified into five types of psychological needs. In the second phase, a fully immersive, interactive, easy-to-use VR platform was developed that reflected these psychological needs. Patients with dementia experienced the VR content. The researchers assessed the level of the participants’ immersion, preference, and interaction with the VR using a 5-point Likert scale. Results In the feasibility test, 10 nursing home residents were recruited. The mean immersion score was 4.93 ± 0.16 points, the mean preference score was 4.35 ± 0.41 points, and the mean interaction score was 3.84 ± 0.43 points using a 5-point Likert scale. Higher mean scores indicated a more positive outcome. Six of the 10 participants required assistance while using the VR. The mean VR experience duration was 10.00 ± 3.46 min. Conclusions The VR-based intervention program that was developed to reduce BPSD was feasible for the participants and provided them with a high degree of satisfaction and immersion. Furthermore, this study also confirmed the convenience and safety of the program. These findings support the potential use of VR-based BPSD intervention programs to treat patients with dementia.

scholarly journals Non-Pharmacological Interventions for Post-Stroke Fatigue: Systematic Review and Network Meta-Analysis

2020 ◽  
Vol 9 (3) ◽  
pp. 621 ◽  
Author(s):  
Ya Su ◽  
Michiko Yuki ◽  
Mika Otsuki
Keyword(s):  
Systematic Review ◽  
Health Management ◽  
Behavioral Therapy ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Pharmacological Intervention ◽  
Pharmacological Interventions ◽  
Post Stroke ◽  
Equivalent Efficacy ◽  
Fatigue Severity

Post-stroke fatigue (PSF) is one of the most serious sequelae, which often interferes with the rehabilitation process and impairs the functional recovery of patients. Due to insufficient evidence, it is unclear which specific pharmacological interventions should be recommended. Therefore, in this paper, we compare the effectiveness of non-pharmacological interventions in PSF. A systematic review and network meta-analysis of randomized controlled trials were performed using EMBASE, MEDLINE, CINAHL, Cochrane library, ClinicalTrials.gov, CNKI, and CQVIP, from inception to January 2018, in the English and Chinese languages. RCTs involving different non-pharmacological interventions for PSF with an outcome of fatigue measured using the Fatigue Severity Scale were included. Multiple intervention comparisons based on a Bayesian network are used to compare the relative effects of all included interventions. Ten RCTs with eight PSF non-pharmacological interventions were identified, comprising 777 participants. For effectiveness, most interventions did not significantly differ from one another. The cumulative probabilities of the best non-pharmacological intervention for fatigue reduction included Community Health Management (CHM), followed by Traditional Chinese Medicine (TCM) and Cognitive Behavioral Therapy (CBT). Network meta-analysis based on data from the selected RCTs indicated that the eight PSF non-pharmacological interventions shared equivalent efficacy, but CHM, TCM, and CBT showed potentially better efficacy. In the future, fatigue needs to be recognized and more accurate assessment methods for PSF are required for diagnosis and to develop more effective clinical interventions.

scholarly journals Randomized controlled trial of mibampator for behavioral and psychological symptoms of dementia: comments on the trial and thoughts for future studies

2013 ◽  
Vol 25 (5) ◽  
pp. 687-689 ◽  
Author(s):  
Clive Ballard ◽  
Paul Francis ◽  
Anne Corbett
Keyword(s):  
Psychological Symptoms ◽  
Controlled Trial ◽  
Treatment Options ◽  
Significant Risk ◽  
Good Evidence ◽  
Adverse Outcomes ◽  
Pharmacological Intervention ◽  
First Line ◽  
Long Term Treatment ◽  
Behavioral And Psychological Symptoms

Behavioral and psychological symptoms of dementia (BPSD) frequently arise in people with Alzheimer's disease (AD) and other dementias. They cause significant distress and confer risk to the person and others, in addition to presenting a complex clinical challenge for treatment (Ballard et al., 2009b). There is good evidence for the value of first-line management strategies such as psychological interventions and treatment of concurrent medical conditions, particularly pain, which are known to be effective (Ballard et al., 2009b). However, there are limited pharmacological treatment options for severe aggression, which causes significant risk, and for other severe BPSD which do not respond to first-line approaches. The only pharmacological intervention with an adequate evidence base is the prescription of atypical antipsychotics, where 18 placebo-controlled trials have evaluated the effect of treatment over 6–12 weeks. The literature indicates modest but significant benefits in the treatment of aggression and psychosis with risperidone and aripiprazole (Cohen's d standardized effect size of 0.2), uncertain benefits with olanzapine, and no benefits with quetiapine (Ballard and Howard, 2006; Schneider et al., 2006a; Ballard et al., 2009b; Corbett et al., 2012). Unfortunately, the benefits of longer term prescribing are more limited (Schneider et al., 2006b; Ballard et al., 2008) and there have been increasing concerns regarding the potential for serious adverse outcomes, including accelerated cognitive decline, stroke, and death (Schneider et al., 2006b; Ballard et al., 2009a). There is therefore an urgent imperative to identify more effective pharmacological treatments for severe BPSD which have a better safety profile, particularly for long-term treatment and prophylaxis. Despite this urgency, there has been very little effort toward developing or evaluating potential novel therapies for the treatment of key symptoms such as aggression, psychosis, restlessness, and apathy.

Managing behavioral and psychological symptoms in Chinese elderly with dementia via group-based music intervention: A cluster randomized controlled trial

Dementia ◽  
2018 ◽  
Vol 18 (7-8) ◽  
pp. 2785-2798 ◽  
Author(s):  
Rainbow TH Ho ◽  
Ted CT Fong ◽  
CY Sing ◽  
Pandora HT Lee ◽  
Alice BK Leung ◽  
...  
Keyword(s):  
Psychological Symptoms ◽  
Well Being ◽  
Pharmacological Intervention ◽  
Control Group ◽  
Music Intervention ◽  
Intervention Effects ◽  
Chinese Elderly ◽  
Cluster Randomized ◽  
And Control ◽  
Behavioral And Psychological Symptoms

The present study aimed to evaluate the effects of a group music intervention in managing behavioral and psychological symptoms in Chinese elderly with dementia. This cluster randomized trial recruited 73 elderly participants with moderate dementia from 10 elderly residential homes and assigned them to the intervention ( n = 40) and control ( n = 33) group. The intervention included 16 half-hour sessions of music intervention with multi-sensory components over eight weeks and control group received standard care. Participants’ levels of subjective moods and neuropsychiatric symptoms such as agitation, aberrant motor behaviors, dysphoria, and irritability were assessed at baseline, the 2nd, 4th, 6th, and the end of the intervention. Controlling for baseline outcomes, latent growth modeling revealed significant intervention effects for agitation ( B = −1.03, SE = 0.30, p < 0.01), aberrant motor behavior ( B = −1.80, SE = 0.66, p < 0.01), and dysphoria ( B = −0.79, SE = 0.36, p < 0.05), with the intervention group showing improvements compared to no substantial changes in the control group. There were no significant intervention effects on irritability or subjective mood ( p > 0.05). The music intervention showed significant reduction in the behavioral and psychological symptoms in Chinese elderly patients with dementia. Elderly homes could adopt this practical non-pharmacological intervention as a strategy to improve the well-being of the elderly.

scholarly journals Developing a Virtual Reality for People With Dementia and Mild Cognitive Impairment Based on Their Psychological Needs: A Feasibility Study

2020 ◽  
Author(s):  
Jung-Hee Kim ◽  
Seonmin Park ◽  
Hyeongji Lim
Keyword(s):  
Virtual Reality ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Intervention Program ◽  
Psychological Symptoms ◽  
Psychological Needs ◽  
Second Phase ◽  
People With Dementia ◽  
The Mean ◽  
Behavioral And Psychological Symptoms

Abstract BackgroundPurpose of this study was to develop a virtual reality (VR) intervention program based on the psychological needs of patients with dementia and mild cognitive impairment residing in nursing facilities in Korea to relieve their behavioral and psychological symptoms, and to confirm the possibility of utilizing VR in patients with dementia and mild cognitive impairment.MethodsIn the first phase, surveys and questionnaires were used to identify activities that relieved the behavioral and psychological symptoms of dementia (BPSD) among patients. These activities were classified into five types of psychological needs. In the second phase, a fully immersive, interactive, easy-to-use VR platform was developed that reflected these psychological needs. The VR content was used with patients with dementia and mild cognitive impairment. The researchers assessed the level of the participants’ immersion, preference, and interaction with the VR, using a 5-point Likert scale. ResultsIn the feasibility test, the mean immersion score was 4.93 ± 0.16 points, the mean preference score was 4.35 ± 0.41 points, and the mean interaction score was 3.84 ± 0.43 points. Six out of 10 participants required assistance while using the VR. The mean VR experience duration was 10.00 ± 3.46 minutes.ConclusionsThe VR-based intervention program that was developed to reduce BPSD was feasible for the participants, and provided them with a high degree of satisfaction and immersion. Furthermore, this study also confirmed the convenience and safety of the program. These findings provide evidence for the potential of VR to provide BPSD intervention programs for patients with dementia and mild cognitive impairment, and potentially for other geriatric conditions.

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

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.

scholarly journals Nonpharmacological Interventions to Reduce Behavioral and Psychological Symptoms of Dementia: A Systematic Review

2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Alexandra Martini de Oliveira ◽  
Marcia Radanovic ◽  
Patrícia Cotting Homem de Mello ◽  
Patrícia Cardoso Buchain ◽  
Adriana Dias Barbosa Vizzotto ◽  
...  
Keyword(s):  
Systematic Review ◽  
Key Words ◽  
Sleep Problems ◽  
Psychological Symptoms ◽  
Behavioral Symptoms ◽  
Pharmacological Interventions ◽  
Significant Efficacy ◽  
Positive Results ◽  
Behavioral And Psychological Symptoms

Introduction. Behavioral and psychological symptoms of dementia (BPSD) are defined as a group of symptoms of disturbed perceptive thought content, mood, or behavior that include agitation, depression, apathy, repetitive questioning, psychosis, aggression, sleep problems, and wandering. Care of patients with BPSD involves pharmacological and nonpharmacological interventions. We reviewed studies of nonpharmacological interventions published in the last 10 years.Methods. We performed a systematic review in Medline and Embase databases, in the last 10 years, until June 2015. Key words used were (1) non-pharmacological interventions, (2) behavioral symptoms, (3) psychological symptoms, and (4) dementia.Results. We included 20 studies published in this period. Among these studies, program activities were more frequent (five studies) and the symptoms more responsive to the interventions were agitation.Discussion. Studies are heterogeneous in many aspects, including size sample, intervention, and instruments of measures.Conclusion. Nonpharmacological interventions are able to provide positive results in reducing symptoms of BPSD. Most studies have shown that these interventions have important and significant efficacy.

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