Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea.
Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea; School of Nursing, Inha University, Incheon, Republic of Korea.
Int J Nurs Stud. 2024 Nov;159:104866. doi: 10.1016/j.ijnurstu.2024.104866. Epub 2024 Jul 30.
Non-pharmacological interventions are considered the first-line treatment for managing the behavioral and psychological symptoms of dementia. Given the heterogeneous characteristics of these symptoms, which vary for each individual and tend to fluctuate, a symptom-specific approach is necessary for providing individualized non-pharmacological interventions for people with dementia. However, clear guidelines regarding the appropriate types of interventions for individual symptoms or clusters of behavioral and psychological symptoms of dementia are lacking.
The aim of this umbrella review was to summarize the current evidence on non-pharmacological interventions for behavioral and psychological symptoms of dementia and provide guidance for determining the appropriate types of interventions for each behavioral and psychological symptom of dementia.
An umbrella review of systematic reviews and/or meta-analyses.
The Cochrane methodology for umbrella reviews was employed for this review, and the review protocol was registered. PubMed, CINAHL, Embase, PsycINFO, and Cochrane databases were searched for relevant reviews using the 'population, intervention, control, and outcomes' formulation. Two reviewers independently screened the extracted articles for eligibility. The quality of each selected review was independently assessed by the two reviewers using A Measurement Tool to Assess Systematic Reviews 2. The results were narratively synthesized and categorized according to each symptom.
Thirty-five systematic reviews, 71 % of which were also meta-analyses, were included in this review. The methodologies employed in the included reviews were significantly heterogeneous. The qualities of the reviews ranged from low to moderate. Diverse types of non-pharmacological interventions were identified in the reviews, with music therapy being the most frequently discussed. Among the various symptoms, depression was most frequently addressed, followed by overall symptoms, agitation, anxiety, sleep problems, and apathy. Music therapy was found to be effective for improving both overall and specific symptoms, including depression and anxiety. Notably, relatively weak evidence supports the effectiveness of exercise in addressing each symptom. Aromatherapy could be considered for agitation, whereas reminiscence may be effective in managing overall and specific symptoms, such as depression.
The results showed that the evidence of symptom-specific effectiveness of non-pharmacological interventions varied across the different behavioral and psychological symptoms of dementia, highlighting the need for a symptom-specific approach in future research. Furthermore, future research is needed to facilitate the development of symptom-specific guidelines that can enhance the quality of individualized dementia care.
Registered with PROSPERO (number: CRD42022340930) on November 9, 2022.
非药物干预被认为是管理痴呆患者行为和心理症状的一线治疗方法。鉴于这些症状具有异质性特征，每个个体的症状各不相同且往往波动不定，因此需要针对痴呆患者的个体症状提供特定于症状的非药物干预。然而，对于特定症状或行为和心理症状群的适当干预类型，目前缺乏明确的指南。
本综述的目的是总结非药物干预痴呆患者行为和心理症状的现有证据，并为确定针对每个痴呆患者的行为和心理症状的适当干预类型提供指导。
对系统评价和/或荟萃分析进行综述。
本综述采用 Cochrane 综述方法，并对综述方案进行了注册。使用“人群、干预、对照和结局”的表述方式，在 Cochrane 数据库、PubMed、CINAHL、Embase、PsycINFO 和 Cochrane 数据库中搜索相关综述。两位审查员独立筛选提取的文章以确定其是否符合纳入标准。两位审查员使用 A Measurement Tool to Assess Systematic Reviews 2 独立评估每个选定综述的质量。结果按照每个症状进行叙述性综合和分类。
本综述共纳入 35 篇系统评价，其中 71%的系统评价还进行了荟萃分析。纳入的综述所采用的方法学存在显著的异质性。综述的质量从低到中不等。综述中确定了多种类型的非药物干预措施，其中音乐治疗讨论得最多。在各种症状中，抑郁最常被提及，其次是总体症状、激越、焦虑、睡眠问题和淡漠。音乐治疗被发现对改善总体和特定症状（包括抑郁和焦虑）均有效。值得注意的是，相对较弱的证据支持运动对每个症状的有效性。芳香疗法可用于激越，而怀旧疗法可能对管理总体和特定症状（如抑郁）有效。
结果表明，非药物干预针对不同痴呆行为和心理症状的特定症状有效性的证据存在差异，这突出表明未来的研究需要采用特定于症状的方法。此外，需要开展进一步的研究，以制定特定于症状的指南，从而提高痴呆个体化护理的质量。
2022 年 11 月 9 日在 PROSPERO（编号：CRD42022340930）上注册。
