Regier Natalie G, Gitlin Laura N
Center for Innovative Care in Aging, Johns Hopkins School of Nursing, 525 North Wolfe Street, SON House Room 301, Baltimore, MD, 21205, USA.
Department of Community and Public Health, Johns Hopkins School of Nursing, 525 N. Wolfe Street, Suite 316, Baltimore, MD, 21205, USA.
Curr Treat Options Psychiatry. 2017 Mar;4(1):80-101. doi: 10.1007/s40501-017-0105-1. Epub 2017 Feb 6.
Nearly all persons with dementia will exhibit behavioral and psychological symptoms (BPSD) at some point during the course of the disease. These symptoms often pose significant challenges for formal and informal caregivers, and their treatment is unclear. Current guidelines recommend implementing nonpharmacological interventions as the first-line approach to managing BPSD. Given the recent proliferation of research evaluating the use of nonpharmacological interventions for BPSD, there is a continuing need to reevaluate and synthesize the findings in this area. The current review examines the evidence for using psychosocial and environmental strategies, focusing on the past 3 years of research efforts and assessing how this research augments what is known from prior reviews. We conclude that the results in the recent literature concerning the efficacy of psychosocial and environmental treatment approaches to behavioral symptoms in dementia continue to be promising, yet results are also mixed. We recommend the consideration of music therapy and tailored activities when utilizing a nonpharmacological approach, as these appear particularly promising throughout the literature. We also find that multisensory stimulation and animal-assisted therapy warrant further evaluation. In contrast, in this and previous reviews, approaches such as bright light therapy and aromatherapy have consistently been shown to be ineffective and, thus, cannot be recommended with confidence based on the evidence. We discuss limitations of current research studies and make recommendations for future research in the area of psychosocial and environmental interventions for BPSD.
几乎所有痴呆症患者在病程中的某个阶段都会出现行为和心理症状（BPSD）。这些症状常常给专业和非专业护理人员带来重大挑战，而且其治疗方法尚不明晰。当前指南建议将实施非药物干预作为管理BPSD的一线方法。鉴于近期评估非药物干预用于BPSD的研究大量涌现，持续重新评估和综合该领域的研究结果很有必要。本综述审视了使用心理社会和环境策略的证据，重点关注过去三年的研究成果，并评估这些研究如何补充先前综述中的已知内容。我们得出结论，近期文献中关于痴呆症行为症状的心理社会和环境治疗方法疗效的结果依然很有前景，但结果也参差不齐。我们建议在采用非药物方法时考虑音乐疗法和量身定制的活动，因为在整个文献中这些方法似乎特别有前景。我们还发现多感官刺激和动物辅助疗法值得进一步评估。相比之下，在本次及先前的综述中，诸如强光疗法和芳香疗法等方法一直被证明无效，因此，基于现有证据无法自信地推荐这些方法。我们讨论了当前研究的局限性，并对BPSD心理社会和环境干预领域的未来研究提出了建议。
