The Effect of a Multimodal Occupational Therapy Program with Cognition-Oriented Approach on Cognitive Function and Activities of Daily Living in Patients with Alzheimer's Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Min-Joo Ham,Ye-Ji Jo,Doo-Han Yoo,Minho Moon,Chisoo Park,Yunkwon Nam,Sujin Kim

doi:10.3390/biomedicines9121951

Abstract

Non-pharmacological intervention, which includes a broad range of approaches, may be an alternative treatment for Alzheimer’s disease (AD). Multimodal non-pharmacological intervention alleviates cognitive dysfunction and the impairment of activities of daily living (ADL) in AD patients. However, it is still unclear which combination of non-pharmacological interventions is preferred. We selected a non-pharmacological intervention combined with occupational therapy (OT). We investigated the effect of a multimodal OT program with cognition-oriented approach on cognitive dysfunction and impairments of ADL in patients with AD. Four electronic databases were searched from January 2000 to August 2020. The studies were assessed for heterogeneity, quality assessment, effect size and publication bias. A total of seven randomized controlled trials examining multimodal OT programs with cognition-oriented approach in AD patients were included in the meta-analysis. Compared with the control group, the multimodal OT program with cognition-oriented approach group was statistically beneficial for cognitive dysfunction (95% CI: 0.25–0.91). However, compared with the control group, the multimodal OT program with cognition-oriented approach group tended to be beneficial for basic ADL, and instrumental ADL. These results suggest that the multimodal OT program with cognition-oriented approach might be the optimal multimodal non-pharmacological intervention for improving cognitive dysfunction in AD patients.

Highlights

The inclusion criteria were as follows: (1) studies on patients with Alzheimer’s disease (AD); (2) studies on multimodal occupational therapy (OT) program with cognition-oriented approach; (3) studies measuring changes in overall cognitive function or activities of daily living (ADL); (4) randomized controlled trials (RCTs); (5) studies published in English; and (6) studies that indicated the sizes of the intervention and control groups, the means and standard deviations, or the standardized mean difference (SMD) scores
Among the various combinations of multimodal prisingly, our results are consistent with a previous study that showed that multimodal non-pharmacological interventions, we investigated the effect of a multimodal OT prointervention combined with OT, such as art therapy, language therapy, physical training, gram with cognition-oriented approach thattraining, seeks for a patient-centered approach
If further studies are conducted on this topic, we propose to increase the number of experimental studies examining the effects of a multimodal OT program with cognition-oriented approach on ADL disability in patients with dementia

Summary

Introduction

Dementia is defined as a state in which daily living is severely disrupted by a combination of symptoms, such as memory impairment, aphasia, apraxia, agnosia, or impaired executive function caused by an acquired brain disease [1]. Accounts for 55–70% of all dementia cases and is clinically characterized by gradually worsening severe memory loss that causes impairment of daily living [2]. Treatment approaches for patients with AD are divided into pharmacological and non-pharmacological approaches. According to the DSM-5 [3], ADL is mentioned as an important diagnostic criterion along with cognitive factors in the definition of dementia.

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Discussion

Conclusion