Non-pharmacological interventions for people with Alzheimer's Disease: A critical review of the scientific literature from the last ten years

Abstract

Currently, non-pharmacological interventions are useful, versatile and potentially cost-effective tools for managing the care of people suffering from Alzheimer's Disease (AD). The aim of the present study is to examine non-pharmacological interventions in terms of their theoretical basis and empirical evidence in improving cognition and autonomy of daily living and reducing neuropsychiatric symptoms in people with AD. We searched the electronic databases from January 2005 until 15 November 2015 using a combination of the terms “Alzheimer's Disease and Reality Orientation”, “Cognitive Stimulation Therapy”, “Reminiscence”, “Psychodynamic therapy”, “Spaced retrieval”, “Music Therapy”, “Bright light therapy”. Non-pharmacological interventions can be grouped into four categories: Holistic techniques, Brief psychotherapies, Cognitive methods and Alternative strategies. Reality orientation and Cognitive stimulation therapy (CST) were associated with a significant improvement in cognition and behaviour in mild to moderate AD patients and in reinforcing concomitant pharmacological treatment. Reminiscence was found to enhance cognition and reduce depressive symptoms. Spaced retrieval may facilitate retention and recall of meaningful items. Further research needs to be conducted to establish the impact of Bright light therapy on neuropsychiatric disturbances in AD, while the use of Music Therapy may lead to a reduction of the frequency and the extent of them. Methodological limitations such as the paucity of randomized-controlled trials and small samples size have been observed. Non-pharmacological interventions represent complementary techniques and should be tailored case by case, according to patients’ medical condition and resilience, compliance to treatment, AD severity, available sanitary and professional resources and caregiver care commitment and support.