PURPOSE: Mild cognitive impairment, Alzheimer’s disease (AD) and dementia are associated with onset behavioral disturbances such as depression, psychosis, and anxiety. These ailments affect overall outcomes, decrease quality of life, and are primarily treated with antidepressants. However, there are additional therapies available to alleviate and mitigate these onset disturbances. Based on published clinical data, this comprehensive review and meta-analysis evaluates the effects of alternative therapies and treatments on behavioral outcomes in patients with mild cognitive impairment (MCI), mild or moderate AD, and dementia. METHODS: We applied novel clinical data extraction and aggregation technologies developed by MedAware Systems, Inc. It is a patent-pending process where two scientists, blinded to each other, extract data from the same study. Intelligent software compares each data field for matches (or mismatches). A senior scientist reconciles data mismatches. Where pre- and post-treatment outcomes are available, a standardized mean difference is calculated as the MedAware Standardized Index of treatment effect (MSI-E). This methodology was used to examine differences in efficacy and behavioral outcomes among the alternative treatments (supplements, therapy and counseling, exercise, education and training, and rehabilitation) to identify efficacious treatments for behavioral outcomes. RESULTS: A total of 89 studies reporting anxiety and depression outcomes in patients with MCI, AD or dementia were located. There were no significant differences in MSI-E among treatments. Cognitive and behavioral showed the most efficacy (MSI-E = 0.023 ± 0.002). Among alternative treatment categories, there were no significant differences, with rehabilitation showing the most efficacy (MSI-E = +0.254 ± 0.063), and exercise showing the least (MSI-E = -0.105 ± 0.013). CONCLUSIONS: Using the MedAware Systems, Inc. literature database and meta-analytic methodology, we found that rehabilitation therapy may decrease anxiety and depression, while exercise has almost no effect. Overall results for alternative therapies were not significant. Because the number of studies within each therapy is small, additional research on alternative therapies is warranted. Supported by MedAware Systems, Inc.
Read full abstract