Effectiveness of non-pharmacological interventions for cognitive impairment in Parkinson’s disease: systematic review protocol

REVIEW QUESTION / OBJECTIVE The objective of this review is to identify the effectiveness of combined cognitive and physical interventions on the risk of falls in cognitively impaired older adults. INCLUSION CRITERIA Types of participants Older persons who are 65 years or older will be included. Studies where the majority of participants have been indicated through mean ages and standard deviations will also be eligible for inclusion. Participants who have been diagnosed or identified as having a cognitive impairment will be included in this review. The participants will be characterized as having a cognitive impairment through: 1. Diagnosis of a dementia or cognitive impairment or other condition which directly results in reduced cognition. 2. Reduced Mini Mental State Examination or other such global assessment of cognition, e.g. through the Montreal Cognitive Assessment. Participants will not be limited by dementia diagnosis (i.e. Alzheimer's disease, vascular, mild cognitive impairment), but their cognitive impairment must be acquired and progressive in nature. Studies with a population of older adults with an increased risk of falls will be considered but will only be included if more than 75% of the total sample has reduced cognition identified in the criteria above. Types of intervention(s)/phenomena of interest This review will consider publications that describe multifactorial or multiple interventions where a physical and cognitive element has been noted by the authors or reviewers. It is the aim of this review to capture studies which have a combined physical and cognitive element in the intervention; however studies which TRUNCATED AT 250 WORDS

In spite of recent progress in the pharmacotherapy of depression major issues are still unresolved. These include the non-response rate of approximately 30% to conventional antidepressant pharmacotherapy, side effects of available antidepressants and the latency of several weeks until clinical improvement. The only non-pharmacological biological treatment options available so far which exert more rapid antidepressant efficacy are electroconvulsive therapy and, as an augmentation strategy, sleep deprivation. Current pharmacological treatments aim to enhance serotonergic and/or noradrenergic neurotransmission. In spite of emerging knowledge, the crucial mechanisms underlying both non-pharmacological treatments, which are responsible for antidepressant efficacy, are not yet clear so far. In the meantime several new pharmacological principles are under investigation with regard to their putative antidepressant potency. These include 5-HT1A receptor agonists, tachykinin receptor antagonists and various interventions within the hypothalamic-pituitary-adrenal system. While there is evidence for antidepressant properties of these new treatments in animal studies, in case series, in open studies and to some degree also in placebo controlled studies, no definite proof for the antidepressant efficacy of these new pharmacological strategies according to the requirements for evaluation of antidepressant drugs has been furnished so far. In contrast, for the established non-pharmacological treatment strategies including bright light therapy the clinical efficacy has been proven at least in subgroups of depression, but more knowledge of the main mechanisms underlying their antidepressant efficacy is still necessary. In addition new non-pharmacological treatments like repetitive transcranial magnetic stimulation, magnetic seizure therapy and Vagus nerve stimulation are currently under development. Nevertheless, a follow-up of both the new pharmacological strategies and non-pharmacological treatment options is of major importance to provide even better strategies for the clinical management of depression, which also is of great socio-economic impact.

Background:Frailty syndrome is a medical condition defined by a progressive loss of function that usually begins beyond 65 and necessitates assistance with daily activities. There are both pharmacological and nonpharmacological approaches to prevent frailty. The purpose of this systematic review is to investigate viable nonpharmacological therapies for reducing frailty among the elderly in low- and middle-income countries, to develop an appropriate guideline to determine the applicability of these nonpharmacological interventions in various feasible settings.Methods:Two independent researchers will explore 5 electronic databases for relevant and promising studies. The selected articles will be subjected to a full-text examination following the initial screening. Two independent authors will analyze the risk of bias using the Cochrane risk of bias assessment tool. The review findings on various nonpharmacological approaches to prevent frailty will be presented as a narrative synthesis. There will be a sensitivity analysis and an assessment of study heterogeneity if possible.Results and conclusion:The systematic review protocol has been evaluated and approved by the institutional review board of North South University. The preferred reporting items for systematic review and meta-analysis protocol recommendations for precisely reporting health care interventions and the Cochrane group standards will be strictly followed in this systematic review protocol.PROSPERO Registration number:CRD42021290417

IntroductionPost-traumatic stress disorder (PTSD) is associated with an increased risk of dementia. Individual epidemiological studies have controlled for several confounders of the relationship between PTSD and increased dementia risk, yet particular risk factors underlying this relationship have not been determined. This systematic review protocol aims to identify risk and protective factors of dementia among adults with PTSD.Methods and analysisWe will conduct an electronic search of the databases: PubMed, CINAHL, PsychINFO, The Cochrane Library, Scopus and ProQuest Dissertation and Theses Global. After screening the studies, quantitative synthesis will be performed, if possible. Otherwise, a narrative synthesis will be performed. We will include randomised controlled trials and other types of research evidence including longitudinal cohort studies. Strength of evidence will be assessed using the Grading of Recommendations, Assessment, Development and Evaluations method. Examples of variables that will be extracted are: year of PTSD diagnosis, comorbid conditions, health behaviours, pharmacological treatments and year of mild cognitive impairment or dementia diagnosis. We developed this systematic review protocol according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 statement.Ethics and disseminationThe proposed study will not collect individual-level data and, therefore, does not require ethical approval. Results of this study will provide current evidence on risk and protective factors of dementia in adults with PTSD. Findings will be disseminated in peer-reviewed publications and conference presentations.PROSPERO registration numberCRD42019128553.

IntroductionAlzheimer’s disease (AD) is the most common neurodegenerative disease and is characterised by cognitive impairment. Non-pharmacological treatments such as diet therapy have been widely investigated in studies on AD. Given...

This review aims to assess and synthesize the existing literature on the effectiveness and safety of intranasal fentanyl versus no intervention, placebo, non-pharmacological, or pharmacological interventions for pain management in infants aged 0-6months. Pain management in infants, especially given their exposure to frequent painful procedures, is a crucial concern. The potential benefits of intranasal fentanyl are notable, but comprehensive guidelines for its use in infants is lacking. This review will include experimental and non-experimental quantitative studies comparing intranasal fentanyl, at any dose/frequency, for pain management in infants aged 0-6months, against comparators such as no intervention, placebo, or other pharmacological and non-pharmacological interventions. Procedures will include those considered to be tissue-breaking, needle-related, non-tissue-breaking, or any procedure deemed to be painful. The primary outcome will be pain intensity during procedures, chosen for its relevance in evaluating the effectiveness of intranasal fentanyl. Secondary outcomes will include pain response, recovery, frequency of repeated dosing, and safety. Studies in any language will be considered. This review will adhere to the JBI methodology for systematic reviews and the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. A 3-step search strategy will be used to search databases (Cochrane Library, MEDLINE, Embase, CINAHL, Scopus) without date restrictions. The search results will be reported in a PRISMA flow diagram. Two independent reviewers will extract detailed data on participants, methods, interventions, and outcomes. Certainty will be assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) and JBI appraisal tools to evaluate study quality and bias risk. Data synthesis will combine findings using statistical models, or narrative summaries when meta-analysis is not feasible. PROSPERO CRD42024551524.

Depression is one of the most common mental health issues prevalent in end-stage renal disease (ESRD) patients requiring hemodialysis, yet there is limited evidence on the best approach to treat depression in hemodialysis patients. A narrative review was conducted to examine the effectiveness of both pharmacological and non-pharmacological interventions, including antidepressant medications, dietary and herbal supplements, cognitive behavioral therapy (CBT), psychotherapy, acupressure, and exercise regimens to alleviate depressive symptoms and improve the quality of life as evaluated by various depression and quality of life screening tools and questionnaires.A database search was conducted in the University of South Wales Library as well as the MEDLINE database, and relevant articles published in the English language and fitting the inclusion criteria, which mainly comprised articles assessing outcomes in terms of improvement in depression symptoms and quality of life, were selected for the purpose of this review. A total of 29 randomized controlled trials (RCT) were included in this review, of which eight studied pharmacological treatment methods and 21 studies examined non-pharmacological or psychosocial interventions to treat depression.The pharmacological interventions include antidepressant medications and supplements, compared with a placebo or another active intervention. Sertraline, as a selective serotonin reuptake inhibitor (SSRI) in hemodialysis patients, has conflicting evidence base, whereas there is inconclusive evidence for the effectiveness of fluoxetine and citalopram. The role of supplements is promising in this population cohort and needs further research to justify their use in treating depression. The non-pharmacological methods include CBT, guided imagery, psychotherapy, endurance-resistance training, exercise training, mindfulness-based stress reduction, acupressure, tele-nursing, Benson relaxation technique, hope therapy, and internet-based intervention. CBT is the most widely studied intervention and proves to be effective against wait-listed patients, but does not prove to have a more beneficial effect when compared to psychotherapy. Various exercise regimens, including endurance-resistance training and intra-dialysis exercise, show good results in alleviating depressive symptoms, but further research is required in this field to establish these methods as a treatment option in the future. Other interventions such as hope therapy, internet-based measures, guided imagery, tele-nursing, Benson relaxation technique, and mindfulness-based stress reduction all have very limited evidence, although they have been trialed in studies.This review combines both pharmacological and non-pharmacological treatment options and their effectiveness in treating depression in hemodialysis patients. Dietary and herbal supplements have low-grade evidence, whereas more research is required for SSRIs in treating depression. CBT is useful to improve depression scores and quality of life, along with psychotherapy. A standardized approach and follow-up of patients throughout the treatment and follow-up period, along with a greater sample size and assessment of outcomes through more standardized tools and questionnaires, would improve the quality of evidence collected, which will ultimately aid in establishing an evidence-based method of addressing an important health concern, that is, depression in hemodialysis patients.

Primary dysmenorrhoea (PD) is the most common gynaecological condition among young women and is associated with significant socioeconomic repercussions. It is unclear which works best for pain relief when pharmacological and non-pharmacological interventions are compared. This systematic review and network meta-analysis (NMA) will aim to compare and rank the effects of pharmacological and non-pharmacological interventions in patients with PD. Randomised controlled trials of pharmacological and non-pharmacological interventions for PD will be identified via a search of the PubMed, Cochrane Library, Web of Science, Embase, Scopus database and Google Scholar search engine until September 2025. The primary outcome will be a change in pain intensity among patients with PD, while the secondary outcomes include health-related quality of life, symptoms of depression and anxiety, and treatment-related adverse events. Two independent reviewers will perform document screening, study selection and data extraction. The methodological quality of the included studies will be assessed using the Cochrane Risk of Bias tool (V.2). The RevMan, Stata and Aggregate Data Drug Information System software will be used to perform a pairwise meta-analysis and Bayesian NMA in a random-effects model. The certainty of the evidence will be rated using the Grading of Recommendations, Assessment, Development, and Evaluation System. This systematic review protocol is exempt from ethical approval as it involves analysis of previously published data. The findings of this review will be submitted to peer-reviewed journals. CRD42024543573.

Cognitive impairment (impairment of memory, attention, or concentration) is documented in 17-75% of patients with various malignancies treated with chemotherapeutic agents that worsen quality of life. CRCI affects patients of all ages. The impairment of cognitive function in connection with chemotherapy is usually mild, but an event. relationship with dementia remains to be confirmed. Chemotherapy in combination with radiotherapy in Hodgkin lymphoma can cure 80-90% of patients. This review summarizes the most frequently observed changes in cognitive function in patients suffering from CRCI. The article further describes the possible pathophysiological mechanisms behind these changes and the risk factors that can increase the likelihood of cognitive functional impairment after chemotherapy of malignant tumors. Special attention is given to how this relates to Hodgkins lymphoma. We also discuss the neuroprotective factors involved in chemotherapy-related cognitive impairment and its treatment options. Changes occur mainly in the ability to learn and remember, in the speed of reactions, and in attention and executive functions. Although CRCI pathophysiological mechanisms are complex and not yet fully understood, the involvement of neurotoxicity, such as that induced by treatment, anemia, higher levels of oxidative stress and inflammatory responses, genetic factors, and reduced brain connectivity is discussed. CRCI is further modified by comorbidities and patient age. Pharmacological and nonpharmacological treatment options for CRCI are outlined.Key words: Hodgkin lymphoma - chemotherapy - cognitive impairment - risk factors The project was supported by the grant of the Agency for the Czech Republic Health Research of the Ministry of Health of the Czech Republic 16-29857A and by the project Sustainability for the National Institute of Mental Health No. LO1611 with a financial support of the Ministry of Education, Youth and Sports of the Czech Republic in the frame of the National Sustainability Programme I. The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.Submitted: 29. 9. 2016Accepted: 12. 2. 2017.

IntroductionPain management in patients with cancer is a critical aspect of oncological care, yet remains challenging with current pharmacological therapies. Non-pharmacological interventions, offering potential benefits without the adverse effects of...

IntroductionDespite the growing volume of published studies on the effects of positive psychology interventions (PPIs), little is known about their effectiveness outside of Western countries, particularly in Arab countries. As...

BackgroundPeople diagnosed with schizophrenia and other severe mental illness (SMI) have a reduced life expectancy compared to the general population, which can partly be explained by their increased risk of...

IntroductionThe focus on medical management and secondary prevention following Transient Ischemic Attack (TIA) and minor stroke is well-established. Evidence is emerging that people with TIA and minor stroke can experience lasting impairments as fatigue, depression, anxiety, cognitive impairment, and communication difficulties. These impairments are often underrecognized and inconsistently treated. Research in this area is developing rapidly and an updated systematic review is required to evaluate new evidence as it emerges. This living systematic review aims to describe the prevalence of lasting impairments and how they affect the lives of people with TIA and minor stroke. Furthermore, we will explore whether there are differences in impairments experienced by people with TIA compared to minor stroke.MethodsSystematic searches of PubMed, EMBASE, CINAHL, PsycINFO, Cochrane Libraries will be undertaken. The protocol will follow the Cochrane living systematic review guideline with an update annually. A team of interdisciplinary reviewers will independently screen search results, identify relevant studies based on the defined criteria, conduct quality assessments, and extract data. This systematic review will include quantitative studies on people with TIA and/or minor stroke that report on outcomes in relation to fatigue, cognitive and communication impairments, depression, anxiety, quality of life, return to work/education, or social participation. Where possible, findings will be grouped for TIA and minor stroke and collated according to the time that follow-up occurred (short-term < 3 months, medium-term 3–12 months, and long-term > 12 months). Sub-group analysis on TIA and minor stroke will be performed based on results from the included studies. Data from individual studies will be pooled to perform meta-analysis where possible. Reporting will follow the Preferred Reporting Items for Systematic review and Meta-Analysis Protocol (PRISMA-P) guideline.PerspectivesThis living systematic review will collate the latest knowledge on lasting impairments and how these affect the lives of people with TIA and minor stroke. It will seek to guide and support future research on impairments emphasizing distinctions between TIA and minor stroke. Finally, this evidence will allow healthcare professionals to improve follow-up care for people with TIA and minor stroke by supporting them to identify and address lasting impairments.

More than 1 million individuals undergo cardiothoracic surgery for coronary artery bypass graft or valve repair/replacement annually in the United States. There is an increased risk of developing serious cognitive impairment post cardiothoracic surgery. Pharmacological interventions and surgical techniques were associated with improvements in cognitive function in previous systematic reviews. However, a gap in the literature exists regarding how nonpharmacological interventions can mitigate cognitive impairment in adults undergoing cardiac surgery. The aim of this study was to explore the effectiveness of nonpharmacological interventions to reduce the detrimental effects of cardiac surgery on cognitive function in patients after cardiothoracic surgery. CINAHL, MEDLINE, PubMed, EMBASE, PsycINFO, and Web of Science databases were searched following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines from January 2011 to February 2022. Nineteen studies were included in this review. Researchers defined cognitive impairment differently across studies. Various interventions were used to reduce cognitive impairment post cardiothoracic surgery, with the most common being remote ischemic limb conditioning. The interventions used to reduce cognitive impairment were heterogeneous in outcomes, measurements, and time of assessment, but only 2 interventions were associated with a reduction in cognitive impairment. This review is a unique synthesis of the quality of interventions that address broader components of cognition. Researchers used various interventions to reduce cognitive impairment; the outcomes, instruments, and time interval for measurements were heterogeneous. Researchers should conduct future studies at multiple time intervals, using a comprehensive measure of cognitive impairment to better understand the impact of cognitive impairment interventions postoperatively.

IntroductionFibromyalgia (FM) is an unexplained chronic condition characterised by generalised pain, sleep disturbances, autonomic disturbances, anxiety, fatigue and cognitive impairment. FM is a prevalent chronic disease worldwide that imposes a...