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Non-drug treatments for symptoms in dementia: an overview of systematic reviews

What do we want to know?

The Department of Health commissioned the Policy Innovation Research Unit (PIRU) to carry out a systematic review of the effectiveness of non-pharmacological treatments or therapies for managing neuropsychiatric symptoms and challenging behaviours in patients with dementia.

Dementia is a progressive degenerative condition that currently affects about 700,000 older adults in the UK. Patients with dementia often suffer from neuropsychiatric symptoms and challenging behaviours, such as agitation, aggression and psychosis. These can cause major problems for both dementia patients and their carers, with the latter often reporting high levels of distress and depressive symptoms. Antipsychotic drugs, which were developed to treat patients with mental health problems such as schizophrenia, are now one of the main treatments for managing behavioural and psychological symptoms in patients with dementia. However, emerging evidence suggests that, not only do these drugs have few benefits for patients with dementia, they may pose significant risks, especially if used longterm, such as an increased risk of falls, blood clots, stroke and heart problems. For these reasons, the Department of Health is committed to achieving a significant two-thirds reduction in the use of antipsychotic medication among patients with dementia. Despite current clinical guidance which recommends the use of non-pharmacological approaches (i.e. treatments or therapies other than medication) to improve behavioural and psychological symptoms in patients with dementia, the widespread use of antipsychotics for these patients continues.

Who wants to know?

Policy-makers, health professionals, researchers, research funding bodies, patients and carers.

What did we find?

In all, 19 non-pharmacological treatments were identified in the systematic reviews. Of these, the most consistent evidence for effectively managing behavioural and psychological symptoms was found for behaviour management techniques delivered by professional staff, and for staff and caregiver training and support. There was promising evidence for four other alternative treatments – physical activity/exercise; massage/touch therapies; multi-sensory stimulation (e.g. snoezelen, aromatherapy) and music therapy – although the evidence for these was not as robust, either because the primary studies were not as rigorous, the results were more mixed or the evidence available was limited. Only one treatment appeared to be ineffective – validation therapy. For the vast majority of treatments, however, the evidence was inconclusive, either because it was inconsistent across primary studies, or these studies were of poor quality, or the evidence was almost totally lacking.

What are the implications?

A general lack of high quality evidence mean that the systematic reviews included in our overview refrained from making policy and practice recommendations. More and better research is needed on these alternative interventions in order to inform future policy and practice.

How did we get these results? 

We carried out an ‘overview’ of reviews which involved examining thirty recent systematic reviews in order to summarise their results on the effectiveness of alternative treatments.

This report should be cited as:

Dickson K, Lafortune L, Kavanagh J, Thomas J, Mays N, Erens B (2012) Non-drug treatments for symptoms in dementia: an overview of systematic reviews of non-pharmacological interventions in the management of neuropsychiatric symptoms and challenging behaviours in patients with dementia. London: Policy Innovation Research Unit, London School of Hygiene and Tropical Medicine.

ISBN: 978 0 902657 86 0

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