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      Nonpharmacological Therapies in Alzheimer’s Disease: A Systematic Review of Efficacy


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          Introduction: Nonpharmacological therapies (NPTs) can improve the quality of life (QoL) of people with Alzheimer’s disease (AD) and their carers. The objective of this study was to evaluate the best evidence on the effects of NPTs in AD and related disorders (ADRD) by performing a systematic review and meta-analysis of the entire field. Methods: Existing reviews and major electronic databases were searched for randomized controlled trials (RCTs). The deadline for study inclusion was September 15, 2008. Intervention categories and outcome domains were predefined by consensus. Two researchers working together detected 1,313 candidate studies of which 179 RCTs belonging to 26 intervention categories were selected. Cognitive deterioration had to be documented in all participants, and degenerative etiology (indicating dementia) had to be present or presumed in at least 80% of the subjects. Evidence tables, meta-analysis and summaries of results were elaborated by the first author and reviewed by author subgroups. Methods for rating level of evidence and grading practice recommendations were adapted from the Oxford Center for Evidence-Based Medicine. Results: Grade A treatment recommendation was achieved for institutionalization delay (multicomponent interventions for the caregiver, CG). Grade B recommendation was reached for the person with dementia (PWD) for: improvement in cognition (cognitive training, cognitive stimulation, multicomponent interventions for the PWD); activities of daily living (ADL) (ADL training, multicomponent interventions for the PWD); behavior (cognitive stimulation, multicomponent interventions for the PWD, behavioral interventions, professional CG training); mood (multicomponent interventions for the PWD); QoL (multicomponent interventions for PWD and CG) and restraint prevention (professional CG training); for the CG, grade B was also reached for: CG mood (CG education, CG support, multicomponent interventions for the CG); CG psychological well-being (cognitive stimulation, multicomponent interventions for the CG); CG QoL (multicomponent interventions for PWD and CG). Conclusion: NPTs emerge as a useful, versatile and potentially cost-effective approach to improve outcomes and QoL in ADRD for both the PWD and CG.

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          Most cited references109

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          Exercise program for nursing home residents with Alzheimer's disease: a 1-year randomized, controlled trial.

          To investigate the effectiveness of an exercise program in improving ability to perform activities of daily living (ADLs), physical performance, and nutritional status and decreasing behavioral disturbance and depression in patients with Alzheimer's disease (AD). Randomized, controlled trial. Five nursing homes. One hundred thirty-four ambulatory patients with mild to severe AD. Collective exercise program (1 hour, twice weekly of walk, strength, balance, and flexibility training) or routine medical care for 12 months. ADLs were assessed using the Katz Index of ADLs. Physical performance was evaluated using 6-meter walking speed, the get-up-and-go test, and the one-leg-balance test. Behavioral disturbance, depression, and nutritional status were evaluated using the Neuropsychiatric Inventory, the Montgomery and Asberg Depression Rating Scale, and the Mini-Nutritional Assessment. For each outcome measure, the mean change from baseline to 12 months was calculated using intention-to-treat analysis. ADL mean change from baseline score for exercise program patients showed a slower decline than in patients receiving routine medical care (12-month mean treatment differences: ADL=0.39, P=.02). A significant difference between the groups in favor of the exercise program was observed for 6-meter walking speed at 12 months. No effect was observed for behavioral disturbance, depression, or nutritional assessment scores. In the intervention group, adherence to the program sessions in exploratory analysis predicted change in ability to perform ADLs. No adverse effects of exercise occurred. A simple exercise program, 1 hour twice a week, led to significantly slower decline in ADL score in patients with AD living in a nursing home than routine medical care.
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            Meta-Analysis of Psychosocial Interventions for Caregivers of People with Dementia

            To review published reports of interventions for caregivers (CGs) of persons with dementia, excluding respite care, and provide recommendations to clinicians.
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              Walking or vitamin B for cognition in older adults with mild cognitive impairment? A randomised controlled trial.

              To examine the effects of aerobic exercise or vitamin B supplementation on cognitive function in older adults with mild cognitive impairment (MCI). Randomised placebo-controlled trial. General community. Community-dwelling adults aged 70-80 with MCI. Interventions : The 152 participants were randomly assigned to two (1) a twice-weekly, group-based, moderate-intensity walking programme (WP, n = 77) or a low-intensity placebo activity programme (n = 75) for one year; and (2) daily vitamin pill containing 5 mg folic acid, 0.4 mg vitamin B-12, 50 mg vitamin B-6 (FA/B12/B6, n = 78) or placebo pill (n = 74) for one year. Cognitive function, measured with neuropsychological tests at baseline and after six and 12 months. Median session attendance at the exercise programmes (25th-75th percentile) was 63% (2%-81%) and median compliance with taking pills (25th-75th percentile) was 100% (99%-100%). Gender was an effect modifier. Intention-to-treat analysis revealed no main intervention effect for either intervention. In women in the WP, attention (Stroop combination task) improved by 0.3 seconds (p = 0.04) and memory (auditory verbal learning test) by 0.04 words (p = 0.06) with each percentage increase in session attendance. In men attending at least 75% of the sessions, the WP improved memory (beta 1.5 (95% CI: 0.1 to 3.0) words). The walking programme and/or FA/B12/B6 supplementation were not effective in improving cognition within one year. The walking programme, however, was efficacious in improving memory in men and memory and attention in women with better adherence. International Standard Randomised Controlled Trial Number Register, 19227688, http://www.controlled-trials.com/isrctn/

                Author and article information

                Dement Geriatr Cogn Disord
                Dementia and Geriatric Cognitive Disorders
                S. Karger AG
                September 2010
                10 September 2010
                : 30
                : 2
                : 161-178
                aMaria Wolff Foundation, bNoscira and cSuperior Council of Scientific Research, Madrid, and dHospital del Mar and Municipal Institute of Medical Research, Barcelona, Spain; eBangor University, Bangor, fUniversity College London, London, gNewcastle University, Newcastle, and hCochrane Dementia and Cognitive Improvement Group, Oxford, UK; iNew York University Medical Center, New York, N.Y., jUniversity of Arkansas for Medical Sciences, Little Rock, Ark., kAlzheimer’s Association, Chicago, Ill., and lUniversity of Washington School of Nursing, Seattle, Wash., USA; mMAS Alzheimerhelp, Bad Ischl, Austria; nHong Kong Polytechnic University, Hong Kong, SAR, China; oKarolinska Institutet, Stockholm, Sweden; pUniversity of New South Wales, Sydney, N.S.W., Australia; qDivision of Neurology, University of British Columbia, Vancouver, B.C., Canada, and rNeuroscience, Bristol Myers Squibb, Wallingford, Conn., USA
                Author notes
                *Ruben Muñiz, Maria Wolff Foundation, Río Sil 15, ES–28669 Boadilla del Monte, Madrid (Spain), Tel. +34 609 170 712, Fax +34 916 320 363, E-Mail ruben@mariawolff.es
                316119 Dement Geriatr Cogn Disord 2010;30:161–178
                © 2010 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 3, Tables: 2, References: 233, Pages: 18
                Review Article

                Geriatric medicine,Neurology,Cardiovascular Medicine,Neurosciences,Clinical Psychology & Psychiatry,Public health
                Alzheimer’s disease, nonpharmacological therapy,Efficacy evaluation


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