Zucchella Chiara, Sinforiani Elena, Tamburin Stefano, Federico Angela, Mantovani Elisa, Bernini Sara, Casale Roberto, Bartolo Michelangelo
Neurology Unit, University Hospital of Verona, Verona, Italy.
Alzheimer's Disease Assessment Unit, Laboratory of Neuropsychology, IRCCS Mondino Foundation, Pavia, Italy.
Front Neurol. 2018 Dec 13;9:1058. doi: 10.3389/fneur.2018.01058. eCollection 2018.
Alzheimer's disease (AD) and dementia are chronic diseases with progressive deterioration of cognition, function, and behavior leading to severe disability and death. The prevalence of AD and dementia is constantly increasing because of the progressive aging of the population. These conditions represent a considerable challenge to patients, their family and caregivers, and the health system, because of the considerable need for resources allocation. There is no disease modifying intervention for AD and dementia, and the symptomatic pharmacological treatments has limited efficacy and considerable side effects. Non-pharmacological treatment (NPT), which includes a wide range of approaches and techniques, may play a role in the treatment of AD and dementia. To review, with a narrative approach, current evidence on main NPTs for AD and dementia. PubMed and the Cochrane database of systematic reviews were searched for studies written in English and published from 2000 to 2018. The bibliography of the main articles was checked to detect other relevant papers. The role of NPT has been largely explored in AD and dementia. The main NPT types, which were reviewed here, include exercise and motor rehabilitation, cognitive rehabilitation, NPT for behavioral and psychological symptoms of dementia, occupational therapy, psychological therapy, complementary and alternative medicine, and new technologies, including information and communication technologies, assistive technology and domotics, virtual reality, gaming, and telemedicine. We also summarized the role of NPT to address caregivers' burden. Although NPT is often applied in the multidisciplinary approach to AD and dementia, supporting evidence for their use is still preliminary. Some studies showed statistically significant effect of NPT on some outcomes, but their clinical significance is uncertain. Well-designed randomized controlled trials with innovative designs are needed to explore the efficacy of NPT in AD and dementia. Further studies are required to offer robust neurobiological grounds for the effect of NPT, and to examine its cost-efficacy profile in patients with dementia.
阿尔茨海默病（AD）和痴呆症是慢性疾病，其认知、功能和行为会逐渐恶化，最终导致严重残疾和死亡。由于人口的不断老龄化，AD和痴呆症的患病率持续上升。这些疾病给患者、其家庭和护理人员以及卫生系统带来了巨大挑战，因为需要大量资源分配。目前尚无针对AD和痴呆症的疾病修饰干预措施，且症状性药物治疗疗效有限且副作用较大。非药物治疗（NPT）包括多种方法和技术，可能在AD和痴呆症的治疗中发挥作用。本文采用叙述性方法回顾了AD和痴呆症主要非药物治疗的现有证据。检索了PubMed和Cochrane系统评价数据库中2000年至2018年发表的英文研究。检查主要文章的参考文献以发现其他相关论文。NPT在AD和痴呆症中的作用已得到广泛研究。本文回顾的主要NPT类型包括运动和运动康复、认知康复、针对痴呆症行为和心理症状的NPT、职业治疗、心理治疗、补充和替代医学以及新技术，包括信息和通信技术、辅助技术和智能家居、虚拟现实、游戏和远程医疗。我们还总结了NPT在减轻护理人员负担方面的作用。尽管NPT经常应用于AD和痴呆症的多学科治疗方法中，但其使用的支持证据仍属初步。一些研究显示NPT对某些结果有统计学上的显著影响，但其临床意义尚不确定。需要精心设计的创新设计随机对照试验来探索NPT在AD和痴呆症中的疗效。还需要进一步研究为NPT的效果提供有力的神经生物学依据，并检查其在痴呆症患者中的成本效益情况。
