Interventions to delay functional decline in people with dementia: a systematic review of systematic reviews.
OBJECTIVE
To summarise existing systematic reviews that assess the effects of non-pharmacological, pharmacological and alternative therapies on activities of daily living (ADL) function in people with dementia.


METHODS
Overview of systematic reviews.


METHODS
A systematic search in the Cochrane Database of Systematic Reviews, DARE, Medline, EMBASE and PsycInfo in April 2015. Systematic reviews of randomised controlled trials conducted in people with Alzheimer's disease or dementia measuring the impact on ADL function were included. Methodological quality of the systematic reviews was independently assessed by two authors using the AMSTAR tool. The quality of evidence of the primary studies for each intervention was assessed using GRADE.


RESULTS
A total of 23 systematic reviews were included in the overview. The quality of the reviews varied; however most (65%) scored 8/11 or more on the AMSTAR tool, indicating high quality. Interventions that were reported to be effective in minimising decline in ADL function were: exercise (6 studies, 289 participants, standardised mean difference (SMD) 0.68, 95% CI 0.08 to 1.27; GRADE: low), dyadic interventions (8 studies, 988 participants, SMD 0.37, 95% CI 0.05 to 0.69; GRADE: low) acetylcholinesterase inhibitors and memantine (12 studies, 4661 participants, donepezil 10 mg SMD 0.18, 95% CI 0.03 to 0.32; GRADE: moderate), selegiline (7 studies, 810 participants, SMD 0.27, 95% CI 0.13 to 0.41; GRADE: low), huperzine A (2 studies, 70 participants, SMD 1.48, 95% CI 0.95 to 2.02; GRADE: very low) and Ginkgo biloba (7 studies, 2530 participants, SMD 0.36, 95% CI 0.28 to 0.44; GRADE: very low).


CONCLUSIONS
Healthcare professionals should ensure that people with dementia are encouraged to exercise and that primary carers are trained and supported to provide safe and effective care for the person with dementia. Acetylcholinesterase inhibitors or memantine should be trialled unless contraindicated.


BACKGROUND
CRD42015020179.
Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia.
Kate
K
Laver
Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia.
Suzanne
S
Dyer
Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia.
Craig
C
Whitehead
Ageing, Work and Health Research Unit, University of Sydney, Sydney, New South Wales, Australia.
Lindy
L
Clemson
Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia.
Maria
M
Crotty
D000203:Activities of Daily Living; D000544:Alzheimer Disease / Q000188:drug therapy / Q000628:therapy; D017028:Caregivers; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D000529:Complementary Therapies; D003704:Dementia / Q000188:drug therapy / Q000628:therapy*; D015259:Dopamine Agents / Q000627:therapeutic use; D015444:Exercise; D006801:Humans; D008559:Memantine / Q000627:therapeutic use*; D011788:Quality of Life
D002800:Cholinesterase Inhibitors; D015259:Dopamine Agents; D008559:Memantine
PRIMARY CARE; REHABILITATION MEDICINE