Excerpt

In 2004, the Office of the Assistant Deputy Under Secretary for Health for Policy and Planning estimated that the total number of Veterans with dementia would be as high as 563,758 in FY 2010. The behavioral symptoms that are associated with dementia, such as agitation/aggression, wandering, and sleep disturbances, are associated with increased caregiver burden, decreased quality of life for the patient, and increased healthcare costs. It is estimated that behavioral symptoms occur in as many as 90 percent of people with Alzheimer’s disease (AD). Moreover, it is the behavioral symptoms that are most often cited by caregivers as the reason for the placement of individuals with dementia into residential care.

Psychotropic medications are commonly used to reduce the frequency and severity of the behavioral symptoms of dementia. There is little evidence, however, that such interventions are effective, and their potential side effects are frequent and often hazardous. It has been reported that the use of atypical and typical antipsychotic medication is associated with the increased risk of death.

Because of the limited benefits and the potential harms associated with psychotropic medications, non-pharmacological interventions for the behavioral symptoms associated with dementia may be an attractive alternative to pharmacological treatment. The purpose of this report is to review systematically the evidence on non-pharmacological treatments for behavioral symptoms of dementia.

Contents

• PREFACE
• EXECUTIVE SUMMARY
  • BACKGROUND
  • METHODS
  • RESULTS
• INTRODUCTION
  • BACKGROUND
• METHODS
  • TOPIC DEVELOPMENT
  • SEARCH STRATEGY
  • STUDY SELECTION AND QUALITY ASSESSMENT
  • DATA SYNTHESIS
  • PEER REVIEW
• RESULTS
  • LITERATURE SEARCH
  • KEY QUESTION #1 How do non-pharmacological treatments of behavioral symptoms compare in effectiveness with each other, with pharmacological approaches, and with no treatment?
  • KEY QUESTION #2 How do non-pharmacological treatments of behavioral symptoms compare in safety with each other, with pharmacological approaches, and with no treatment?
  • KEY QUESTION #3 How do non-pharmacological treatments of behavioral symptoms compare in cost with each other, with pharmacological approaches, and with no treatment?
• DISCUSSION
  • FUTURE RESEARCH RECOMMENDATIONS
• CONCLUSIONS
• REFERENCES
• APPENDIX A SEARCH STRATEGY FOR NON-PHARMACOLOGICAL TREATMENT OF DEMENTIA, REVIEWS
• APPENDIX B SEARCH STRATEGY FOR PRIMARY STUDIES ON ANIMAL-ASSISTED THERAPY FOR DEMENTIA
• APPENDIX C INCLUSION/EXCLUSION CRITERIA FOR SYSTEMATIC REVIEWS OF NON-PHARMACOLOGICAL INTERVENTIONS
• APPENDIX D QUALITY RATING CRITERIA FOR SYSTEMATIC REVIEWS
• APPENDIX E INCLUSION/EXCLUSION CRITERIA FOR PET/ANIMAL-ASSISTED THERAPY
• APPENDIX F ABBREVIATIONS
• APPENDIX G REVIEWER COMMENTS AND RESPONSES

Prepared for: Department of Veterans Affairs, Veterans Health Administration, Health Services Research & Development Service, Washington, DC 20420. Prepared by: Evidence-based Synthesis Program (ESP) Center, Portland VA Medical Center, Portland, OR, Devan Kansagara, MD, MCR, Director.

Suggested citation:

O'Neil M, Freeman M, Christensen V, Telerant A, Addleman A, and Kansagara D. Non-pharmacological Interventions for Behavioral Symptoms of Dementia: A Systematic Review of the Evidence. VA-ESP Project #05-225; 2011

This report is based on research conducted by the Evidence-based Synthesis Program (ESP) Center located at the Portland VA Medical Center, Portland, OR funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development. The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs. No investigators have any affiliations or financial involvement (e.g., employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in the report.