Fakhoury Nora, Wilhelm Nathaniel, Sobota Kristen F, Kroustos Kelly R
Consult Pharm. 2017 Oct 1;32(10):623-628. doi: 10.4140/TCP.n.2017.623.
Worldwide, dementia is the most important contributor to disability in elderly patients. Treating patients with dementia can be challenging for clinicians because of the numerous behavioral and psychological symptoms of dementia (BPSD). The Dementia Action Alliance and American Geriatrics Society Beers criteria promote nonpharmacological and behavioral treatments as first-line therapy to manage BPSD to avoid adverse events associated with antipsychotic medications. Some of the nonpharmacologic therapies proposed for BPSD include: music therapy (MT), light therapy, acupressure, aromatherapy, massage, and animal-assisted therapy. However, several are supported with only limited literature findings. Among these, MT has the most substantial data. MT has demonstrated benefit throughout mild-severe stages of dementia. The extended impact is attributed to associated brain pathology. MT's mode of delivery is essential to the evidencebased use of music interventions and delivery methods. The literature citations show that adequately trained individuals should ideally conduct several forms of MT to obtain optimal benefit. There are several studies investigating the impact of the various forms of MT on alleviating BPSD. Among the numerous reviewed studies, six trials and three meta-analyses were included in this article. While the literature conflicts, MT is noninvasive, poses little to no risk to patients, requires minimal training, and offers large potential for implementation in the patient-care setting. In addition, MT can have an important role in fostering student pharmacist development, because an emphasis on the aging demographic is becoming increasingly important.
在全球范围内,痴呆症是老年患者残疾的最重要原因。由于痴呆症存在众多行为和心理症状(BPSD),对痴呆症患者进行治疗对临床医生而言可能具有挑战性。痴呆症行动联盟和美国老年医学会Beers标准提倡将非药物和行为治疗作为管理BPSD的一线疗法,以避免与抗精神病药物相关的不良事件。针对BPSD提出的一些非药物疗法包括:音乐疗法(MT)、光疗法、指压疗法、芳香疗法、按摩和动物辅助疗法。然而,其中几种疗法仅有有限的文献研究支持。在这些疗法中,MT的数据最为充分。MT已在痴呆症的轻度至重度阶段均显示出益处。这种广泛的影响归因于相关的脑部病变。MT的实施方式对于基于证据使用音乐干预措施和实施方法至关重要。文献引用表明,理想情况下应由经过充分培训的人员开展多种形式的MT,以获得最佳效果。有多项研究调查了各种形式的MT对减轻BPSD的影响。在众多综述研究中,本文纳入了六项试验和三项荟萃分析。尽管文献存在争议,但MT是非侵入性 的,对患者几乎没有风险,所需培训极少,并且在患者护理环境中具有很大的实施潜力。此外,MT在促进学生药剂师的发展方面可以发挥重要作用,因为对老龄化人口的关注正变得越来越重要。