Non-pharmacological Interventions For People Research Articles

Non-Pharmacological Interventions for People with Parkinson’s Disease: Are We Entering a New Era?

Non-Pharmacological Interventions for People with Parkinson’s Disease: Are We Entering a New Era?

Effectiveness of conservative non-pharmacological interventions in people with muscular dystrophies: a systematic review and meta-analysis

IntroductionManagement of muscular dystrophies (MD) relies on conservative non-pharmacological treatments, but evidence of their effectiveness is limited and inconclusive.ObjectiveTo investigate the effectiveness of conservative non-pharmacological interventions for MD physical management.MethodsThis...

A systematic review of the effects of non-pharmacological interventions in people with dementia and cognitive impairment

Abstract Background: Age-related cognitive decline, reducing a person’s abilities in areas of cognition, such as attention, memory, language, or visuospatial ability increasingly gains importance, as the human lifespan increases. When cognitive decline is pathologic and a form of dementia is diagnosed, interventions seek to recognize and counteract typical pathological patterns. On the one hand, pharmacological approaches, such as cholinesterase inhibitors and memantine are proven go-to solutions but are increasingly complemented by therapeutic and non-pharmacological interventions, such as cognitive behavioral therapy, physical and cognitive stimulation, psychosocial interventions, and in recent years even virtual-reality based interventions. Objective: Furthermore, as the objective of the study was to specifically analyze dementia in a certain age group, namely patients over 63 years, studies looking primarily at younger patients were excluded. As dementia has progressive characteristics, the studies were then grouped by diagnosis and the stage of progression, and the results were analyzed according to the reported effectiveness of the non-pharmacological interventions applied. Methods: For this review, three literature databases, namely PubMed, SCOPUS, and ERIC were scanned using a Boolean search with keywords related to different types of dementia, such as Huntington’s, Parkison’s, or vascular dementia. Following the approach outlined in the PRISMA statement, a multi-step process was then executed, reducing the 412 studies by deduplicating them, removing case studies, meta-studies, and, studies suffering from deficiencies, such as lacking a sufficient description of the non-pharmacological intervention applied. Results: Of the 412 studies encountered, only 11 (n = 1353 people) were found to be suitable for inclusion after removing meta-studies, and studies with an unsuitable population, or a lack of information regarding the chosen therapeutic approach. case studies or had an insufficient amount of information regarding the chosen sample. The reviewed studies indicated that physical stimulation had positive effects on cardiovascular disease in patients with dementia and positively correlated with an improvement of executive functions. Another important finding was psychosocial intervention, consisting of cognitive behavioral therapy (CBT) and cognitive rehabilitation improves general cognition, while no consistent results were obtained regarding the effects on specific areas of cognition. For both types of interventions, physical and mental stimulation, the length of the intervention positively correlated with the improvement of the scores. Regarding scores related to quality of life, measured for patients and caregivers alike, cognitive and occupational therapies were found to be a useful tool. Keywords: Dementia, Non-pharmacological intervention, Cognitive impairment, Cognitive rehabilitation, Systematic review, PRISMA statement.

Performing arts as a non-pharmacological intervention for people with dementia and care-partners: a community case study.

Participation in psychosocial enrichment activities, such as music and arts programming, have shown potential to delay or reduce functional decline - without adverse effects that can be associated with pharmaceuticals. The performing-arts programming described in this community case study was inspired by a community music program called B-Sharp Music Wellness, located in Phoenix, Arizona, which involved small groups of musicians who provided symphony performances for people with dementia. Our community programming sought to engage people with dementia and their informal care partner (typically a spouse) in existing performing-arts programs in their local community, providing social hours and season tickets for either symphony, dance (ballet), or non-musical theater performances. This case study describes the program history and design, including outcomes and lessons learned from the program evaluation of the last full season (2018-19) and partial season (2019-20), when the program was halted due to the COVID-19 pandemic. Program outcomes suggest strategies for, and benefits of, design for performing-arts programs as psychosocial interventions in other communities.

Impact of Nutrition on Depression: A Review of Some Dietary Components with Antidepressant Effects and Their Mechanism of Action

Recent years have seen a surge in psychiatric diseases, which has resulted in considerable disease distress and considerably decreased living conditions. Many considerable synthetic medications have been used to treat these illnesses throughout the years, but they have been found to have limited effects and substantial recurrence risks in many individuals. Mental illnesses such as depression and anxiety are persistently on the rise around the world, posing serious challenges to the affected person’s and their family members’ personal lives. There is mounting evidence that suggests the gut–brain axis (GBA) contributes to the genesis and development of psychiatric diseases. This review focuses on contemporary dietary therapies such as Mediterranean diets and dietary supplements and emphasizes nutrition’s critical role in psychiatric care through the GBA. Several research have indicated that dietary quality affects mental health because it controls metabolic processes, has anti-inflammatory and antiapoptotic characteristics, and promotes neurogenesis and synaptogenesis. This study demonstrates many dietary components, their relationships to depression, and how they work. The use of dietary recommendations to support mental health appears to be a novel, affordable, useful, nonpharmacological intervention for people with mental problems.

OP0033 EFFECTIVENESS OF NON-PHARMACOLOGICAL INTERVENTIONS TO PROMOTE WORK PARTICIPATION IN PEOPLE WITH RMDs: A SYSTEMATIC REVIEW AND META-ANALYSIS

BackgroundWork participation among people with rheumatic and musculoskeletal diseases (RMDs) remains reduced when compared to the general population. A EULAR taskforce was established to agree on Points to Consider (PtC) to support people with RMD in healthy and sustainable work participation. Non-pharmacological interventions (NPI) could have an important role in improving work participation in RMDs. However, a comprehensive evidence synthesis of the effectiveness of NPIs in people with RMDs is lacking.ObjectivesTo summarise the literature on effectiveness of NPIs on work participation in people with RMDs.MethodsA search in four databases (MEDLINE, EMBASE, CENTRAL and CINAHL) was performed. Randomised Controlled Trials (RCTs) and Longitudinal Observational Studies (LOS) assessing non-pharmacological/non-surgical interventions until August 2020 were screened. Studies including people with any RMD (except low back pain or work-related RMDs) and assessing a work participation outcome domain (sick leave, work status, presenteeism) were considered eligible. For qualitative evidence synthesis, RCTs and LOS were considered. For quantitative evidence synthesis, only RCTs were considered. For each randomized comparison, standardised mean differences (SMDs) were calculated for the three outcome domains and used as effect size in the meta-analyses; i.e. a negative SMD favouring the NPI over control. Next, Mixed Effects Meta-Regression Analyses were performed, with random effects for randomised comparisons, and a fixed effect factor for the stratified subgroups of clinical interest. Subgroups within diseases (musculoskeletal pain disorders vs. other types of RMDs), risk status for sick leave at baseline (on sick leave or at risk for sick leave; not at risk for sick leave; a combination; or not specified) and single vs. multiple component NPIs were pre-defined. Risk of Bias (RoB) of RCTs was assessed using the Cochrain tool.ResultsOut of 8,864 records, 64 studies (71 treatment comparisons) were included. Studies usually included a mixed population of several RMDs (42%). Most NPIs were conducted in a clinical setting (n=44, 62%) and NPIs usually had multiple components (n=57, 80%), such as vocational support combined with physical training (n=18, 25%). Sick leave was the most frequently reported outcome domain (n=56, 88%). In the qualitative syntheses, 30%/50%/29% of interventions were considered plausible in improving sick leave, work status and presenteeism, respectively.In the quantitative synthesis, NPIs (37 RCTs, 42 comparisons with mostly moderate to high RoB) showed small to moderate effect sizes, favouring NPIs over comparators for sick leave (SMD=-0.23, 95%CI -0.33 to -0.13), work status (SMD=-0.38, 95%CI -0.63 to -0.12) and presenteeism (SMD=-0.25, 95%CI -0.39 to -0.12). The forest plot for sick leave is shown (Figure 1).Subgroup analyses for sick leave revealed that, compared to control, NPIs were not effective in musculoskeletal pain disorders, in contrast to the other types of RMDs. For both other subgroup analyses (baseline risk for sick leave; single vs. multicomponent NPI), NPIs improved sick leave similarly in subgroups compared to the control. Subgroup analyses for work status and presenteeism had generally similar effects in subgroups, but the interpretation requires caution in view of the small number of comparisons. Of note, clinical and methodological heterogeneity between studies was substantial, with some concerns about methodological quality related blinding and completeness of follow up.ConclusionOverall, NPIs seem to have significant, but on the average population level only small to moderate effects on sick leave, work status and presenteeism in RMDs. However, effects on sick leave varied substantially between subgroups. This synthesis suggests that tailoring NPIs to individuals’ needs and context could be clinically valuable.Disclosure of InterestsNone declared.

Effects of reminiscence therapy in people with dementia: A systematic review and meta‐analysis

WHAT IS KNOWN ABOUT ON THE SUBJECT?: Alternative option was developed to improve care due to the increasing costs of care cost and the number of people diagnosed with dementia. Reminiscence therapy is a commonly implemented alternative option used in long-term care facilities. Reminiscence therapy is designed for cognitive decline that is also known as life review. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Reminiscence therapy, known as psychosocial interventions in dementia care, can be used to assist people with dementia recollect prior events, activities, and experiences in order to improve their cognitive, mood, and overall well-being. Reminiscence therapy increased cognitive function and quality of life and reduced depressive and neuropsychiatric symptoms among people with dementia. Reminiscence therapy may be considered a useful non-pharmacological intervention for people with dementia living in nursing homes or other long-term care facilities. The development of a global standard protocol for the application of reminiscence therapy may be necessary for future randomized controlled trials (RCTs). ABSTRACT: Introduction Reminiscence therapy is an alternative to pharmaceutical intervention provided during long-term care, especially for individuals with dementia. However, the effects of reminiscence therapy in dementia care remain inconclusive. Aim The goal of this study is to examine the effects of reminiscence therapy implementation in people with dementia. Design Systematic literature review and meta-analysis were conducted in accordance with the PRISMA guidelines. Methods This study searched systematically using 6 databases. The eligibility criteria included patients with dementia, applied reminiscence therapy, randomized controlled trials or quasi-experimental studies, and published in the English language. The PEDro scale was used to assess the methodological quality of the included studies. The meta-analysis was performed using a random-effects model to calculate the pooled effects of reminiscence therapy. Stata 16.0 was used for statistical analysis. Result A total of 29studies met the eligibility criteria, including 3102 participants. Overall, reminiscence therapy increased cognitive functions and quality of life and decreased depression and neuropsychiatric symptoms. Implication for Practice Reminiscence therapy may be considered a useful non-pharmacological intervention for people with dementia living in nursing homes or other long-term care facilities. A standard protocol for reminiscence therapy may be necessary for future studies.

Olfactory stimulation for people with dementia: A rapid review.

There is a growing interest in using olfactory (smell) stimulation in dementia care. This study aims to extend current knowledge by synthesising the evidence on the efficacy of interventions using olfactory stimulation for people with dementia and to assess the effects of different types of odours and administration methods using a mixed methods approach. The rapid review was conducted based on searches in six electronic databases. A narrative approach was applied to assess 20 studies included in the review. Fourteen studies used a quasi-experimental design, five studies used an experimental design and one was a case study. High heterogeneity was found on odours and methods of application used, with the majority of studies administering lavender oil using a diffuser. Mixed results were reported on the benefits of olfactory stimulation on responsive behaviours and cognitive function. Although the evidence available is limited, encouraging results were found regarding olfactory stimulation and increased sleep duration, food intake and improved balance. It was not possible to draw any overall conclusion in relation to the effect of olfactory stimulation. However, this review shows promising results that support further investigation of olfactory stimulation as a nonpharmacological intervention for people with dementia. The review is limited due to the low to moderate quality of studies included. Furthermore, the broad range of approaches was employed, and comparison between the studies was difficult. Further high-quality mixed method studies using robust and detailed protocols are needed to clarify the effects of olfactory stimuli and any other factors that may influence the responses of people with dementia.

Music therapy for patients with alzheimer’s disease: A focused critical review

Introduction: Dementia is one of the most pressing issues in old age, affecting not only the person who suffers it but also the caregivers and family. Aim: The purpose of this systematic review is to explore the therapeutic value of music as a nonpharmacological intervention for people with AD. A secondary objective is to reveal evidence on the type of music that is most beneficial. Methods: The systematic search included critical review of different databases: Google Scholar, Science Direct, PubMed, Scielo, Dialnet and Cochrane. The search dates ranged from 2006 to 2019 and individual and combinations of the following keywords were used: “Alzheimer’s disease”, “music”, “music therapy” and “dementia” in English, Spanish and Greek. The selected papers were then read in their entirety and further exclusions were made based on ‘fine-tuning’ according to the inclusion and exclusion criteria. Results: Results revealed publications from many different countries such as: Spain, Greece, USA, Netherlands, Brazil, Germany and China. Searching the databases led to the selection of 21 research studies and 7 systematic reviews including a Cochrane review. Discussion: MT has elicited considerable interest amongst researchers and findings clearly illustrate that this innovative and non-invasive method is of great protective advantage to those suffering cognitive decline as found in AD and that responses to MT are evident within a short period of time [within 5 weeks] with as few as one to two half hour sessions per week. Conclusions: MT stimulates cognitive function, improves mood, and reduces behaviour problems triggered by stressful conditions. It is an inexpensive and pleasant intervention with no adverse effects and has emerged as a promising additional therapeutic approach for patients with dementia. It seems that most benefit is achieved when familiar music is enjoyed amongst a group adding a social element to the whole experience.

The Implementation of Birdsong: A Non-Pharmacological Intervention for Persons With Dementia

Birdsong is a person-centered, nonpharmacological intervention for people with dementia. Using a touch-screen tablet, residents with dementia are stimulated with content customized based on individual interests such as sports, videos, music or brain games. The increased stimulation is expected to redirect negative behaviors, decrease the use of anti-psychotic medications and increase positive emotions. Birdsong is being implemented in a 100% Medicaid funded, long-term care facility. Two 10-week experimental design studies were implemented with 39 residents. Preliminary findings suggest a lack of independence with the tablets among the residents, but positive stimulation of emotions and redirection of negative behaviors with assistance of staff or volunteers. A team of practitioners, faculty and student researchers continue to examine the intervention, its implementation and effects on this population by examining the Minimum Data Set (MDS data) and observations of the residents as they utilize Birdsong.

The MAKS-s study: multicomponent non-pharmacological intervention for people with severe dementia in inpatient care \u2013 study protocol of a randomised controlled trial

BackgroundNursing homes accommodate a large number of people with severe dementia. More than 80% of residents with dementia suffer from behavioural and psychological symptoms, that can have consequences on the perceived burden of the formal caregivers. Internationally, the number of studies on non-pharmacological interventions for people with severe dementia is very small. One way to reduce these symptoms is to meet the needs of people with severe dementia. The non-pharmacological group intervention MAKS-s, which we will investigate in this study, is intended to reduce the behavioural and psychological symptoms and to improve the quality of life of such people. Additionally, we will investigate the effects on the burden carried by formal caregivers.MethodsWith the present study, we will investigate the effectiveness of a multicomponent non-pharmacological intervention for people with severe dementia living in nursing homes (primary target group). A power analysis indicated that 144 dementia participants should initially be included. In addition, a secondary target group (nursing home staff) will be examined with respect to their dementia-related stress experiences. The study will be conducted as a cluster randomised controlled trail in Germany with a 6-month intervention phase. The nursing homes in the waitlist control group will provide “care as usual.” The primary endpoints of the study will be the behavioural and psychological symptoms of dementia and the quality of life of people with severe dementia. The total duration of the study will be 18 months. Data will be collected by using observer rating scales.DiscussionThe project has some outstanding quality features. The external validity is high, because it is situated in a naturalistic setting in nursing homes and is being carried out with available nursing employees. Due to this fact, a permanent implementation also seems to be possible. Since the participating nursing homes are disseminated across several German federal states and rural and urban regions, the results should be transferable to the entire population.Trial registrationISRCTN15722923 (Registration date: 07 August 2019).

Cognitive stimulation therapy for dementia: Provision in National Health Service settings in England, Scotland and Wales.

Objectives: Cognitive stimulation therapy (CST) is a brief, non-pharmacological intervention for people with dementia, with an established evidence base for improving cognition and quality of life. It is widely implemented in National Health Service (NHS) settings, but little is known about its naturalistic use. The aim of this survey was to identify and explore inclusion criteria, dose and quality of CST across services in Great Britain (England, Scotland and Wales).Methods: All NHS memory clinics and services for people with dementia were contacted and asked to complete a mixed methods online survey on CST delivery in their service. Questions were centred on who provided CST, who received CST, the dose of CST and any outcomes that were routinely measured.Results: A total of 57/186 services responded, giving a response rate of 30.7%. While the majority reported offering CST (87.7%), there was variability in how this was delivered. Differing inclusion criteria included the use of varying cognitive and behavioural outcome measures, and CST was reported as being offered once and twice weekly. Services also differed in how they evaluated the quality of CST and how this evidence was incorporated for future sessions.Conclusion: While there was a low response rate, this survey indicates that there is significant variability in how CST is used in clinical practice, with many trusts not adhering to the evidence base. To ensure that people with dementia are consistently offered evidence-based, high-quality CST across NHS settings, further standardisation of inclusion criteria, dose and outcomes is needed.

Effectiveness of non-pharmacological falls prevention interventions for people with Multiple Sclerosis, Parkinson’s Disease and stroke: protocol for an umbrella review

Background: Falls are common among people with neurological diseases and are associated with many negative physical, psychosocial and economic consequences. Implementation of single diagnosis falls prevention interventions is currently problematic due to lack of participants and resources. Given the similarities in falls risk factors across stroke, Parkinson’s Disease (PD) and Multiple Sclerosis (MS), the development of an intervention designed for mixed neurological populations seems plausible and may provide a solution to current implementation challenges. This umbrella review aims to summarise the totality of evidence regarding the effectiveness of non-pharmacological falls prevention interventions for people with MS, PD and stroke and to identify the commonalities and differences between interventions that are effective for each disease to inform the development of an intervention for mixed diagnoses. Methods: This umbrella review will be conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Electronic databases and grey literature will be searched. Systematic reviews of randomised controlled trials (RCTS) and studies investigating the effects of non-pharmacological falls prevention interventions on falls outcomes among people with MS, PD and stroke will be included. Methodological quality of included reviews will be assessed using the Assessment of Multiple Systematic Reviews 2 tool. The Grading of Recommendations Assessments, Development and Evaluation framework will be used to rate the quality of evidence. A summary of evidence table and narrative synthesis will be utilised to clearly indicate the findings. Discussion: This umbrella review presents a novel and timely approach to synthesise existing falls literature to identify effective non-pharmacological interventions for people with MS, PD and stroke. Of importance, this umbrella review will use a robust methodology to explore the key differences and similarities in effective interventions for individuals with these neurological diseases to facilitate the development of an intervention for mixed neurological groups.

Doll therapy intervention for women with dementia living in nursing homes: a randomized single-blind controlled trial protocol

BackgroundDoll therapy is a non-pharmacological intervention for people with dementia aimed to reduce distressing behaviours. Reliable results on the efficacy of Doll therapy for people with dementia are needed. The concept of attachment theorised by Bowlby has been proposed to explain the Doll therapy process, but it has not been proven to influence the response to doll presentation.Methods/designThis single-blind, randomised controlled trial will involve people with dementia living in nursing homes of the Canton Ticino (Switzerland). Participants will be randomised to one of two interventions: Doll Therapy Intervention or Sham Intervention with a non-anthropomorphic object, using a 1:1 allocation ratio. The two interventions will consist of 30 daily sessions lasting an hour at most, led by a trained nurse for an hour at most. We will enrol 64 participants per group, according to power analysis using an estimated medium effect size (f = 0.25), an alpha level of 0.05, and a power of 0.8. The primary goal is to test the efficacy of the Doll Therapy Intervention versus the Sham Intervention as the net change in the following measures from baseline to 30 days (blinded outcomes): the Neuropsychiatric Inventory-Nursing Home administered by a trained psychologist blinded to group assignment, the professional caregivers’ perceived stress scale of the Neuropsychiatric Inventory-Nursing Home, patients’ physiological indices of stress (salivary cortisol, blood pressure and heart rate) and interactive behaviours. The secondary goal is to assess the relationship between attachment styles of people with dementia (detected by means of the Adult Attachment Interview to the patients’ offspring) and their caregiving behaviours shown during the Doll Therapy Intervention.DiscussionThis is the first single-blind, randomised controlled trial on the efficacy of Doll therapy for dementia and an explanatory model of the response of people with dementia to doll presentation.Trial registrationClinicalTrials.gov, ID: NCT03224143. Retrospectively registered on 21 July 2017

FINDINGS FROM THE ALZHEIMER’S POETRY PROJECT LONG-TERM CARE IMPLEMENTATION STUDY

Dementia interventions grounded in group participation in the cultural arts (e.g., poetry, storytelling, music, and dance) have been growing in reach in recent decades. Yet this growth has been stymied by a lack of empirical evidence to demonstrate measurable outcomes. In the current IRB-approved research study, the Alzheimer’s Poetry Project (APP), in partnership with 15 Wisconsin nursing homes, provided staff training in an innovative non-pharmacological intervention for people living with dementia. The goal of APP is to facilitate creative self-expression, social and intellectual stimulation, respectful acceptance, validation of personhood, and valued inclusion of people living with Alzheimer's disease and other dementias through the performance and creation of poetry. APP’s proven track record at over 500 facilities in 34 states and six countries internationally, serving over 40,000 people worldwide, demonstrates APP’s ability to bring high-quality creative arts programming to people living with dementia. Through the implementation of APP in three groups of five nursing homes in Wisconsin, activities and care staff were trained to deliver the intervention over three-month periods. After training was completed, researchers evaluated and compared APP to non-arts programming in the same facilities. A novel dementia arts mapping technique was created to document observable impacts of interventions on social engagement, alertness, vocalization, vocabulary, affect, and self-expression. 35 interventions were documented, and variability in participant experiences reveal significantly greater impacts on personhood and creativity during the 11 APP interventions than during the 24 non-arts interventions. Implications for promoting dementia care programming grounded in group participatory arts will be discussed.

Mixed methods implementation research of cognitive stimulation therapy (CST) for dementia in low and middle-income countries: study protocol for Brazil, India and Tanzania (CST-International)

IntroductionIn low/middle-income countries (LMICs), the prevalence of people diagnosed with dementia is expected to increase substantially and treatment options are limited, with acetylcholinesterase inhibitors not used as frequently as in...

The impact of pharmacological and non-pharmacological interventions to improve physical health outcomes in people with schizophrenia: a meta-review of meta-analyses of randomized controlled trials.

We summarized and compared meta-analyses of pharmacological and non-pharmacological interventions targeting physical health outcomes among people with schizophrenia spectrum disorders. Major databases were searched until June 1, 2018. Of 3,709 search engine hits, 27 meta-analyses were included, representing 128 meta-analyzed trials and 47,231 study participants. While meta-analyses were generally of adequate or high quality, meta-analyzed studies were less so. The most effective weight reduction interventions were individual lifestyle counseling (standardized mean difference, SMD=-0.98) and exercise interventions (SMD=-0.96), followed by psychoeducation (SMD=-0.77), aripiprazole augmentation (SMD=-0.73), topiramate (SMD=-0.72), d-fenfluramine (SMD=-0.54) and metformin (SMD=-0.53). Regarding waist circumference reduction, aripiprazole augmentation (SMD=-1.10) and topiramate (SMD=-0.69) demonstrated the best evidence, followed by dietary interventions (SMD=-0.39). Dietary interventions were the only to significantly improve (diastolic) blood pressure (SMD=-0.39). Switching from olanzapine to quetiapine or aripiprazole (SMD=-0.71) and metformin (SMD=-0.65) demonstrated best efficacy for reducing glucose levels, followed by glucagon-like peptide-1 receptor agonists (SMD=-0.39), dietary interventions (SMD=-0.37) and aripiprazole augmentation (SMD=-0.34), whereas insulin resistance improved the most with metformin (SMD=-0.75) and rosiglitazone (SMD=-0.44). Topiramate had the greatest efficacy for triglycerides (SMD=-0.68) and low-density lipoprotein (LDL)-cholesterol (SMD=-0.80), whereas metformin had the greatest beneficial effects on total cholesterol (SMD=-0.51) and high-density lipoprotein (HDL)-cholesterol (SMD=0.45). Lifestyle interventions yielded small effects for triglycerides, total cholesterol and LDL-cholesterol (SMD=-0.35 to -0.37). Only exercise interventions increased exercise capacity (SMD=1.81). Despite frequent physical comorbidities and premature mortality mainly due to these increased physical health risks, the current evidence for pharmacological and non-pharmacological interventions in people with schizophrenia to prevent and treat these conditions is still limited and more larger trials are urgently needed.

Non-pharmacological interventions for people with dementia: A review of reviews.

Aged care services increasingly respond to the needs of people with dementia. Non-pharmacological approaches are preferable to reduce responsive behaviours, improve/maintain functional capacity and reduce emotional disorders. This rapid review of systematic reviews aimed to consolidate the evidence for non-pharmacological interventions and determine outcome effectiveness. Systematic review literature was comprehensively searched for non-pharmacological interventions for dementia in residential care. Quality ratings used adapted GRADE methodology, and ease of implementation assessed. Of 629 abstracts screened, 81 full-text articles were retrieved, 38 articles included. The strongest evidence for reducing responsive behaviours was music, sensory stimulation, simulated presence and validation therapies. Exercise and light therapy improved/maintained activities of daily living, while cognitive stimulation and reminiscence improved cognition. Strongest evidence for reducing emotional disorders was music, psychological interventions and reminiscence. Much evidence of varying quality exists, with resource-constrained residential care providers now able to make evidence-based decisions about non-pharmacological interventions.

The effectiveness of ICT-based neurocognitive and psychosocial rehabilitation programmes in people with mild dementia and mild cognitive impairment using GRADIOR and ehcoBUTLER: study protocol for a randomised controlled trial

BackgroundCognitive rehabilitation is a highly individualised, non-pharmacological intervention for people with mild cognitive impairment (MCI) and dementia, which in recent years has also been developed for various IT platforms.MethodsIn this study, we aim to evaluate the effectiveness of the cognitive rehabilitation software GRADIOR in a multi-centre, single-blinded randomised controlled trial with people with MCI and mild dementia. A total of 400 people with MCI and mild dementia will be randomly allocated to one of four groups. This trial will compare the cognitive rehabilitation treatment using the GRADIOR programme with a psychosocial stimulation intervention (PSS) using the ehcoBUTLER platform, with a combined treatment consisting of GRADIOR and ehcoBUTLER, and with a group receiving treatment as usual during a period of 1 year.DiscussionThe outcomes of this clinical trial will be to determine any relevant changes in cognition, mood, quality of life, activities of daily living and quality of patient-carer relationship after 4 months and 1 year of intervention in a cross-sectional group comparison. Participants will be followed-up for 1 year to investigate potential long-term effects of the conducted treatments.Trial registrationCurrent Controlled Trials ISRCTN, ID: 15742788. Registered on 12 June 2017.

Systematic review of the efficacy of non-pharmacological interventions in people with Lewy body dementia.

We carried out a systematic search using six databases. All human studies examining impact of any non-pharmacological intervention on LBD were assessed for cognitive, physical, psychiatric, and quality-of-life outcomes. Study quality was assessed by Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies and the CARE criteria checklist. Prevailing evidence supporting the efficacy of non-pharmacological interventions is weak. We screened 1,647 papers. Fifteen studies (n = 61) including 11 case reports were found eligible for this systematic review. Interventions and reported outcomes were heterogeneous. Deep brain stimulation of the nucleus basalis of Meynert reportedly conferred cognitive benefit. Electroconvulsive therapy and repetitive transcranial magnetic stimulation have been reported to ameliorate depressive symptoms. Transcranial direct current stimulation was observed to improve attention. Exercise-based interventions reportedly improve various clinically important outcomes. Spaced retrieval memory training and environmental intervention for "mirror sign" have also been reported. Several non-pharmacological interventions have been studied in LBD. Although evidence supporting their efficacy is not robust, prevailing preliminary evidence and limitations of available pharmacological interventions indicate the need to consider appropriate non-pharmacological interventions, while planning comprehensive care of LBD patients. Larger trials evaluating the efficacy of non-pharmacological interventions for LBD are needed.