Maria Wolff Foundation, Madrid, Spain.
Dement Geriatr Cogn Disord. 2010;30(2):161-78. doi: 10.1159/000316119. Epub 2010 Sep 10.
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.
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.
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).
NPTs emerge as a useful, versatile and potentially cost-effective approach to improve outcomes and QoL in ADRD for both the PWD and CG.
非药物治疗（NPT）可以提高阿尔茨海默病（AD）患者及其护理人员的生活质量（QoL）。本研究的目的是通过对整个领域进行系统评价和荟萃分析，评估 NPT 在 AD 和相关障碍（ADRD）中的最佳证据。
对现有综述和主要电子数据库进行了检索，以查找随机对照试验（RCT）。研究纳入的截止日期为 2008 年 9 月 15 日。干预类别和结果领域由共识预先确定。两位共同工作的研究人员共同发现了 1313 项候选研究，其中选择了 179 项 RCT 属于 26 个干预类别。所有参与者都必须记录认知恶化，并且至少 80%的受试者必须存在或假定退行性病因（表明痴呆）。第一作者制定了证据表、荟萃分析和结果摘要，并由作者小组进行了审查。证据水平评级方法和实践推荐分级方法改编自牛津循证医学中心。
为了延迟机构化（对护理人员的多组分干预），实现了对护理人员的 A 级治疗推荐。对痴呆患者（PWD）也达到了 B 级推荐：认知改善（认知训练、认知刺激、PWD 的多组分干预）；日常生活活动（ADL）（ADL 训练、PWD 的多组分干预）；行为（认知刺激、PWD 的多组分干预、行为干预、专业护理人员培训）；情绪（PWD 的多组分干预）；生活质量（PWD 和护理人员的多组分干预）和预防约束（专业护理人员培训）；对护理人员，还达到了 CG 的 B 级：CG 情绪（CG 教育、CG 支持、CG 的多组分干预）；CG 心理幸福感（CG 认知刺激、CG 的多组分干预）；CG 生活质量（PWD 和 CG 的多组分干预）。
NPT 是一种有用、多功能且具有潜在成本效益的方法，可改善 ADRD 中 PWD 和 CG 的预后和生活质量。
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