Nonpharmacological therapies in Alzheimer's disease: a systematic review of efficacy.
BACKGROUND
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.


METHODS
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.


RESULTS
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).


CONCLUSIONS
NPTs emerge as a useful, versatile and potentially cost-effective approach to improve outcomes and QoL in ADRD for both the PWD and CG.
Olazarán
Javier
J
Maria Wolff Foundation, Madrid, Spain.
Reisberg
Barry
B
Clare
Linda
L
Cruz
Isabel
I
Peña-Casanova
Jordi
J
Del Ser
Teodoro
T
Woods
Bob
B
Beck
Cornelia
C
Auer
Stefanie
S
Lai
Claudia
C
Spector
Aimee
A
Fazio
Sam
S
Bond
John
J
Kivipelto
Miia
M
Brodaty
Henry
H
Rojo
José Manuel
JM
Collins
Helen
H
Teri
Linda
L
Mittelman
Mary
M
Orrell
Martin
M
Feldman
Howard H
HH
Muñiz
Ruben
R
D000203:Activities of Daily Living / Q000523:psychology*; D000368:Aged; D000544:Alzheimer Disease / Q000523:psychology / Q000628:therapy; D017028:Caregivers / Q000523:psychology; D015928:Cognitive Behavioral Therapy; D000529:Complementary Therapies / Q000523:psychology*; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D019317:Evidence-Based Medicine; D006801:Humans; D007326:Institutionalization; D059032:Learning Curve; D019636:Neurodegenerative Diseases / Q000523:psychology / Q000628:therapy; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome