title: Quantitative systematic review of the effects of non-pharmacological interventions on reducing apathy in persons with dementia.
abstract: OBJECTIVE
  To review the quantitative evidence concerning the effects of non-pharmacological interventions on reducing apathy in persons with dementia.
  
  
  BACKGROUND
  Apathy, a prevalent behavioural symptom among persons with Alzheimer Disease, is defined as a disorder of motivation with deficits in behavioural, emotional and cognitive domains and is associated with serious social and physical obstacles. Non-pharmacological interventions show promise as symptom control modalities among persons with dementia.
  
  
  METHODS
  Quantitative systematic review.
  
  
  METHODS
  CINAHL, PubMed, PSYCHinfo and Cochrane Trials databases were searched for published English language research inclusive through December 2014, with no early year limiters set.
  
  
  METHODS
  Comprehensive searches yielded 16 international randomized controlled trials or quasi-experimental studies based on inclusion criteria and a rigorous quality appraisal process.
  
  
  RESULTS
  A narrative summary analysis revealed that non-pharmacological interventions for apathy varied substantially and lacked specificity, conceptual clarity and were methodologically heterogeneous. Select interventions demonstrated effectiveness, but lacked systematic long-term follow-up. Limitations include publication bias and lack of a meta-analytic approach due to the methodological heterogeneity of included studies.
  
  
  CONCLUSIONS
  Study results demonstrate promise for the use of non-pharmacological interventions, particularly music-based interventions, in reducing apathy levels in individuals with dementia. Intervening to reduce apathy may have a positive clinical impact and healthcare providers should be encouraged to incorporate positive sources of interest and intellectual stimulation into care. However, future research is needed to examine the aetiologic mechanism and predictors of apathy, to improve evidence-based interventions and specificity and to optimize dosage and timing of non-pharmacological interventions across the disease trajectory.
authors.affiliation: Hope College Nursing Department, A. Paul Schaap Science Center, Holland, Michigan, USA. dykstragoris@hope.edu.
authors.forename: Emilie Dykstra
authors.initials: ED
authors.lastname: Goris
authors.affiliation: University of Michigan School of Nursing, Ann Arbor, Michigan, USA.
authors.forename: Katherine N
authors.initials: KN
authors.lastname: Ansel
authors.affiliation: Wayne State University College of Nursing, Detroit, Michigan, USA.
authors.forename: Debra L
authors.initials: DL
authors.lastname: Schutte
mesh_terms: D057565:Apathy; D001521:Behavior Therapy; D003704:Dementia / Q000523:psychology*; D006282:Health Personnel; D006801:Humans
keywords: Alzheimer's disease; apathy; dementia; gerontology; literature review; non-pharmacological; nursing; passivity; systematic review