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Appendix C: Synthesis of Reviews of Nonpharmacologic Interventions
Pages 293-320

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From page 293...
... Appendix C Synthesis of Reviews of Nonpharmacologic Interventions 293
From page 294...
... 294 REDUCING THE IMPACT OF DEMENTIA IN AMERICA Dates of No. of Studies Studies Included Study Author Method Reviewed  Population Included Designs Cotelli et al., Systematic 2005– Persons living 5 Randomized 2019 review 2016 with mild controlled trial cognitive impairment, Alzheimer's disease, or frontotemporal dementia Tay et al., Systematic 1998– Persons living 11 • Quasi-experimental 2019 review 2017 with dementia • Randomized controlled trial Lim et al., Systematic 2009– Persons in the 9 • Nonrandomized 2019  review 2017 early stages of controlled trial dementia or • Nonrandomized mild cognitive prospective study impairment • Randomized controlled trial Bahar-Fuchs Systematic 1988– Persons living 33 (32 Randomized et al., 2019  review and 2018 with mild included controlled trial meta- to moderate in meta analysis dementia analysis)
From page 295...
... Cognitive-behavioral • Anxiety • Preliminary evidence indicates therapy • Depression cognitive-behavioral therapy is effective at reducing anxiety and depressive symptoms among persons with dementia.  • More rigorous trials are need. Tai chi • Short-term cognitive Tai chi has the potential to improve function short-term cognitive function in the • Global cognitive early stages of dementia.  functions • Working memory and executive function • Verbal learning and memory • Self-perception of memory • Attention and concentration • Semantic memory • Visuospatial skills Cognitive training • Global cognition • Moderate-quality evidence • Clinical disease severity indicates cognitive training • Delayed memory ability relative to control, but not   • Capacity to perform alternative treatment, is associated activities of daily living with small to moderate effects • Mood and well-being of on global cognition and verbal participant  semantic fluency.  • Mood and well-being of • Medium- to long-term follow-up informant/caregiver evidence of cognitive training is • Participant/treatment low.  burden (retention rates)
From page 296...
... van den Berg Systematic 1991– Persons living 17 • Case reports et al., 2018  review 2017 with dementia • Chart review • Prospective cohort Spencer et Systematic 2009 Persons living 1 Cluster randomized al., 2018 review with dementia controlled study Russell- Review 2010– Persons living 10 • Randomized Williams et 2016 with dementia, controlled trial al., 2018 mild cognitive • Quasi-experimental impairment, or subjective cognitive decline
From page 297...
... • Conclusions could not be drawn regarding the effect of music based interventions on social behavior or outcomes at long term follow-up.   Electroconvulsive Agitation and aggression Clinical improvements were observed therapy in most of the studies, but the lack of randomized controlled trials limits inference.  De-escalation • Aggression A single study with high risk of bias techniques for • Behaviors found no difference in change in managing aggression overall behavior.  Meditation: • Stress • Medication may result in – Mindfulness • Cognition improvements in stress, cognition, – Kirtan kriya • Quality of life and quality of life. meditation • More rigorous studies are needed.
From page 298...
... controlled trial Lorusso and Systematic 2001– Persons living 12 • Quasi-experimental Bosch, 2018 review 2014 with dementia • Randomized controlled trial Liang et al., Systematic 2004– Persons living 17 Randomized 2018 review and 2016 with Alzheimer's controlled trial network disease or meta- mild cognitive analysis impairment Hu et al., Systematic 1999– Persons living 10 • Quasi-experimental 2018 review and 2016 with cognitive • Randomized meta- impairment, controlled trial analysis including dementia and mild cognitive impairment
From page 299...
... • Physical exercise • Cognitive functioning • For persons with mild to • Music therapy • Behavior moderate dementia, physical • Computerized exercise may improve cognition. cognitive training • For persons with mild to • Nutrition therapy moderate dementia, computerized cognitive training may improve behavior.
From page 300...
... Individuals with subjective memory complaints, mild cognitive impairment, or Alzheimer's disease (2 studies) Duan et al., Systematic 2006– Persons living 10 Randomized 2018 review and 2016 with dementia controlled trial network meta analysis
From page 301...
... amyloid-B, tau • Home-based • Cognition • Psychosocial interventions exercise • Compliance including walking, home/group • Group exercise exercise, reminiscence therapy, • Walking program and art therapy are more effective • Reminiscence than usual care on measures of therapy cognition. • Art therapy • Nonpharmacologic intervention • Psychosocial + acetylcholinesterase interventions inhibitor is more effective than + acetylcholin- acetylcholinesterase inhibitor esterase inhibitor alone on measures of cognition.
From page 302...
... Deshmukh et Systematic 2006– Persons living 2 Randomized al., 2018 review 2011 with dementia controlled trial Theleritis et Systematic 1998– Persons living 43 • Quasial., 2018 review 2016 with dementia experimental study • Randomized controlled trial Wu et al., Systematic 2005– Persons living 11 • Quasi2017 review and 2015 with dementia experimental meta- studies analysis  • Randomized controlled trial Wood et al., Systematic 2001– Persons living 10 • Quasi2017 mapping 2015 with dementia experimental review studies • Randomized controlled trial
From page 303...
... – Walking • Nonpharmacologic treatment – Emotion- for apathy is safe and may be oriented care effective, but overall, more – Individualized rigorous studies are needed. activity – Reminiscence therapy – Music – Art therapy – Cognitive therapy • Massage Behaviors Low-quality evidence is insufficient to • Touch therapy draw conclusions.
From page 304...
... 304 REDUCING THE IMPACT OF DEMENTIA IN AMERICA Dates of No. of Studies Studies Included Study Author Method Reviewed  Population Included Designs Theleritis et Systematic 2004– Persons living 22 • Quasial., 2017 review and 2016 with Alzheimer's experimental meta- disease studies analysis • Randomized controlled trial Streater et Systematic 1982– Persons living 7 • Quasial., 2017 and 2013 with dementia experimental scoping studies review • Randomized controlled trial
From page 305...
... • Heterogeneity of studies and poor – Reminiscence study designs limit inferences, therapy (group but several nonpharmacologic sessions) interventions are effective in – Individualized reducing apathy.
From page 306...
... Karssemeijer Systematic 2008– Persons living 10 Randomized et al., 2017 review and 2017 with mild controlled trial meta- cognitive analysis impairment or dementia Karkou and Systematic N/A Persons living 0 Randomized Meekums, review with dementia controlled trial 2017
From page 307...
... • Two randomized trials suggest long-term exercise programs may reduce falls. Combined cognitive- • Cognitive function • For persons with dementia, there physical interventions • Activities of daily living is a small to medium positive • Mood effect of combined cognitive– physical interventions on global cognitive function compared with usual care.
From page 308...
... • Reviews (3) Garrido et Critical 2006– Persons living 28 • Nonrandomized al., 2017 synthesis 2016 with dementia clinical trial • Randomized controlled trial Dimitriou Systematic 1998– Persons living 11 Randomized and Tsolaki, review 2013 with dementia controlled trial 2017 Anderson et Systematic 2008– Persons living 7 Randomized al., 2017 review 2015 with dementia controlled trial Abraha et al., Systematic 1997– Persons living 3 • Quasi-randomized 2017 review 2007 with dementia controlled trial • Randomized controlled trial Charry- Systematic 2000– Persons living 23 (8 on • Quasi-experimental Sanchez et review 2017 with dementia, dementia)
From page 309...
... – Therapeutic touch – Foot massage – Aromatherapy and hand massage – Aromatherapy with donepezil Simulated presence • Behaviors Low quality evidence indicates the therapy (audio or • Quality of life effects of simulated presence on video recording) behavioral outcomes is uncertain.
From page 310...
... Garcia-Casal Systematic 2003– Persons living 12 • Quasi-experiential et al., 2017 review and 2014 with dementia • Randomized meta- controlled trial analysis
From page 311...
... Spaced retrieval: • Recall Spaced-retrieval interventions – Name–face • Behavior are viable and may be effective associations in improving recall and reducing – Object–name problem behaviors, but more rigorous associations study designs are needed. – Cue–behavior associations – Mixed goals/ other Music therapy Behavior Findings across studies are mixed.
From page 312...
... Levy et al., Systematic 1995– Older adults 40 (39 on • Quasi-experiential 2017 review 2015 dementia) • Randomized controlled trial
From page 313...
... Reminiscence therapy • Quality of life Heterogeneity of study designs makes • Communication inferences challenging, but overall, • Depression effects are small and inconsistent. • Cognition Complementary and • Agitation • Complementary and alternative alternative medicine: • Delirium medicine had a small effect on – Acupressure reducing agitation.
From page 314...
... O'Caoimh et Systematic 1992– Persons living 48 • Quasi-experiential al., 2019 review and 2018 with mild • Randomized meta- cognitive controlled trial analysis impairment or dementia Zhang et al., Systematic 1987– Persons living 34 • Controlled clinical 2017 review and 2016 with dementia trial meta- • Randomized analysis controlled trial SOURCE: Adapted from Gaugler et al., 2020. [commissioned paper]
From page 315...
... electrical nerve • More rigorous study designs are stimulation needed. – Exercise – Acupressure/ acupuncture – Cognitive behavioral therapy Music therapy  • Behavior • Music therapy compared with • Cognitive function inactive control condition • Depression associated with reductions in • Anxiety behaviors and anxiety.
From page 316...
... . Evaluation of the efficacy of randomized controlled trials of sensory stimulation interventions for sleeping disturbances in patients with de mentia: A systematic review.
From page 317...
... . Animal-assisted intervention for individuals with cognitive impairment: A meta-analysis of randomized controlled trials and quasi-randomized controlled trials.
From page 318...
... Cochrane Database of Systematic Reviews, 2, Cd009812. https://doi.org/10.1002/14651858.
From page 319...
... Cochrane Database of Systematic Reviews, 7, Cd012034. https://doi.org/10.1002/14651858.CD012034.pub2 Streater, A., Coleston-Shields, D.M., Yates, J., Stanyon, M., and Orrell, M


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