title: Nonpharmacological therapies in Alzheimer's disease: a systematic review of efficacy.
abstract: 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.
authors.affiliation: Maria Wolff Foundation, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Olazarán
authors.forename: Barry
authors.initials: B
authors.lastname: Reisberg
authors.forename: Linda
authors.initials: L
authors.lastname: Clare
authors.forename: Isabel
authors.initials: I
authors.lastname: Cruz
authors.forename: Jordi
authors.initials: J
authors.lastname: Peña-Casanova
authors.forename: Teodoro
authors.initials: T
authors.lastname: Del Ser
authors.forename: Bob
authors.initials: B
authors.lastname: Woods
authors.forename: Cornelia
authors.initials: C
authors.lastname: Beck
authors.forename: Stefanie
authors.initials: S
authors.lastname: Auer
authors.forename: Claudia
authors.initials: C
authors.lastname: Lai
authors.forename: Aimee
authors.initials: A
authors.lastname: Spector
authors.forename: Sam
authors.initials: S
authors.lastname: Fazio
authors.forename: John
authors.initials: J
authors.lastname: Bond
authors.forename: Miia
authors.initials: M
authors.lastname: Kivipelto
authors.forename: Henry
authors.initials: H
authors.lastname: Brodaty
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Rojo
authors.forename: Helen
authors.initials: H
authors.lastname: Collins
authors.forename: Linda
authors.initials: L
authors.lastname: Teri
authors.forename: Mary
authors.initials: M
authors.lastname: Mittelman
authors.forename: Martin
authors.initials: M
authors.lastname: Orrell
authors.forename: Howard H
authors.initials: HH
authors.lastname: Feldman
authors.forename: Ruben
authors.initials: R
authors.lastname: Muñiz
mesh_terms: 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