Comparative efficacy of interventions for reducing symptoms of depression in people with dementia: systematic review and network meta-analysis

Prevalence of psychiatric vulnerability and neurocognitive disorders in nursing homes: impact on care levels

PURPOSE

There is an increasing number of residents with more complex needs in nursing homes. Due to the deinstitutionalisation of mental health care, more individuals with psychiatric vulnerabilities are being referred to nursing homes. The aim of this study is to gain insight into the prevalence of psychiatric vulnerability in Belgian nursing homes and its impact on care levels.

METHODS

After screening 3238 patient files of residents in twenty-four Belgian nursing homes, informed consent was obtained from 1155 of the 1608 residents or their legal representatives with a neurocognitive and/or psychiatric diagnosis. Residents were classified into three groups: residents with only a psychiatric diagnosis, with only a neurocognitive diagnosis, and both a psychiatric and neurocognitive diagnosis. The Health of Nations Outcome Scale 65 + was used to assess residents' behaviour, limitations, symptoms, and functioning.

RESULTS

Of all residents, 17.5% had a lifetime psychiatric diagnosis and 41.8% had a neurocognitive disorder. Most prevalent were depressive disorder (8.2%) and Alzheimer's disease (19.3%). Scores for behavioural problems (1.4 and 1.4 versus 0.9, p < 0.0001) and symptoms (5.5 and 5.1 versus 4.4, p < 0,0001) were higher in residents with only a psychiatric or both diagnoses compared to those with only neurocognitive disorders. Conversely, scores for limitations were higher in residents with only a neurocognitive disorder (3.6 versus 2.2 and 3.1, p < 0.0001).

CONCLUSION

With almost 1 in 5 nursing home residents having a psychiatric vulnerability with higher levels of symptoms and behavioural problems, more attention towards improving nursing home caregivers' competence in psychiatric care is recommended.

Impact of dementia-landscaped therapy garden on psychological well-being- A pilot study

Non-pharmacological interventions are increasingly recognized as first-line therapies for managing dementia symptoms alongside pharmacologic strategies. Among these, therapy gardens and horticultural interventions have emerged as promising adjunctive approaches. This pilot study aimed to evaluate the effects of a six-month dementia-friendly therapy garden intervention on psychological well-being, specifically depression levels, and to determine whether baseline dementia severity predicts treatment success. The study was conducted in a real-world setting, with a final sample of 28 dementia patients. Unlike previous studies, this intervention incorporated multimodal stimulation, including sensory, motor, and cognitive elements. Results indicated a significant reduction in depression, as measured by the Montgomery-Åsberg Depression Rating Scale (MADRS) after six months of intervention (p <.05). However, depression scores assessed using the Hamilton Depression Rating Scale (HAM-D) showed only a trend toward improvement but did not reach statistical significance. No improvements were observed at the three-month mark, suggesting that sustained engagement is necessary for measurable benefits. Cognitive function, as assessed by dementia severity, did not show significant improvement, and dementia severity at baseline was not a significant predictor of treatment response. These findings underscore the potential of dementia-friendly therapy gardens to provide meaningful psychological benefits by significantly reducing depression over time. Notably, even individuals with more advanced dementia benefited, challenging the prevailing notion that non-pharmacological interventions are primarily effective in early disease stages. These results highlight the need for further research on the long-term effects and mechanisms underlying garden-based interventions in dementia care.

Factors Influencing the Implementation of Non-Pharmacological Interventions for Behavioural and Psychological Symptoms of Dementia in Residential Aged-Care Homes: A Systematic Review and Qualitative Evidence Synthesis: A systematic review

Background

Non-pharmacological interventions (NPIs) are the primary approaches to the management of behavioural and psychological symptoms of dementia (BPSD), but studies have indicated that there is a suboptimal implementation. Although there are several studies on the factors influencing NPI implementation for BPSD at residential aged-care homes (RACHs), there has not been a comprehensive qualitative systematic review on the topic.

Objectives

This systematic review aimed to examine the qualitative studies that investigate the factors influencing the implementation of NPIs for managing BPSD in RACHs.

Search Methods

Systematic searches were conducted up until 31 December 2023 using five databases: MEDLINE, EMCARE, EMBASE, CINAHL complete and APA PsycINFO.

Selection Criteria

This systematic review included qualitative studies and qualitative data from mixed-method studies on the implementation of NPIs for RACH residents with dementia experiencing BPSD. The research question and inclusion criteria for this review included the components of PICo: Population (aged-care residents with dementia), Phenomenon of interest (factors influencing implementation of NPIs) and Context/setting (RACHs).

Data Collection and Analysis

After screening and extracting the data, the methodological limitations were assessed using the Joanna Briggs Institute System for the Unified Management, Assessment, and Review of Information (JBI SUMARI) quality assessment tool. JBI SUMARI meta-aggregative synthesis was used to synthesise the data. The extracted findings were categorised into the 10 Theoretical Domain Framework domains: knowledge, skills, environmental context and resources, social influences, reinforcement, emotions, intentions, beliefs about consequences, social and professional roles and beliefs about capability. Confidence in the output of qualitative research synthesis (CONQual) was used to assess the credibility and dependability of the synthesised findings.

Main Results

Twenty-four studies were included, from which factors influencing NPI implementation were extracted. Study participants included RACH managers, RACH care staff, families of aged-care residents with dementia and volunteers. Amongst the studies specifying the gender of participants, there were 352 females (84.4%) and 46 males (15.6%). The method of data collection for the included studies consisted of eighteen interviews, five focus group discussions and one qualitative survey. All except one study had a quality assessment score of at least 60% based on the JBI SUMARI quality assessment tool. However, all studies were included regardless of the result of the quality assessment result. These studies spanned the period from 2010 to 2022 and were mostly conducted in the United Kingdom, Australia, the United States and Canada. Twenty-four synthesised findings were identified (13 high, 7 moderate and 4 low ConQual scores). Examples of factors influencing the implementation of NPIs were collaboration amongst care staff and families of residents with dementia, belief in the efficacy of interventions, staffing, staff time constraints, funding, familiarity with the interventions, organisational support, communication amongst the care staff and with families of residents with dementia, education and training for the care staff and families of residents with dementia and familiarity with the residents with dementia.

Authors' Conclusions

This systematic review highlights and synthesises factors influencing the implementation of NPIs for managing BPSD in RACHs. Key factors include collaboration amongst staff and families, organisational support, staffing, education and staff familiarity with both the interventions and residents. Strengthening these areas could enhance the care outcomes for aged-care residents with dementia. For decision-makers, these insights suggest the need for comprehensive strategies to improve NPI implementation. This could include ensuring appropriate staffing levels, enhancing collaboration, allocating adequate funds, providing training, strengthening organisational support and improving the quality of information exchange amongst care staff, between care staff and volunteers and families of residents with dementia. For researchers, the findings from this systematic review could provide valuable insights including the need to explore strategies to overcome barriers to NPI implementation, especially investigating innovative models for staffing and collaborative practice, examining the effectiveness of different education and training approaches, and exploring organisational policies and support mechanisms that can enhance the implementation of NPIs.

Use of antidepressants in early Huntington's Disease: a systematic review and meta-analysis

BACKGROUND

While neuropsychiatric symptoms are common in Huntington's Disease (HD), there is a dearth of evidence about the effectiveness of psychotropic medication for treating behavioral and cognitive symptoms. This article systematically reviews and aggregates the evidence of the effects of antidepressants on individuals with early HD.

METHODS

A systematic review and random-effects meta-analysis of RCTs comparing antidepressants to placebo in individuals with HD was performed, with a focus on outcomes of executive functioning, functional capacity, mood, motor function, and adverse events.

RESULTS

A total of 4 studies with 123 of patients with early HD, of whom a total of 63 (51.2%) received an antidepressant, were identified in our search. In our pooled analysis, a modest but statistically significant improvement in mood resulted from antidepressant treatment in HD (OR -1.22; 95% CI -2.16,-0.27; p = 0.02). No significant differences in the other outcomes of interest were found following antidepressant exposure.

CONCLUSIONS

Our investigation suggests that antidepressant use may modestly improve mood, but not ameliorate functional, cognitive, or movement-related symptoms in mild HD. Further studies involving novel agents, larger samples, and longer follow-up times are needed to better characterize the effect of antidepressants on neuropsychiatric symptoms in HD.

A Systematic Review of the Reminiscence Functions Scale and Implications for Use with Older Adults

OBJECTIVES

The Reminiscence Functions Scale (RFS) is a widely used robust instrument. While reminiscence-based intervention is one of the most effective nonpharmacological interventions for older adults. This systematic review provides a comprehensive synthesis of the literature that used RFS with older adults, summarizes the main outcomes, and highlights implications for practice.

METHODS

This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were eligible if they used RFS and included older adults. Studies were searched from 1993, the year RFS was first published. Electronic databases were searched (Scopus, PsycNET, and Web of Science), from which 44 eligible studies were identified.

RESULTS

Four themes were identified: i) predictive value of reminiscence functions regarding well-being, ii) increased frequency of teach/inform and death preparation functions in older adults, iii) key roles of reminiscence functions in coping with critical life events, iv) reminiscence-based interventions should promote positive memories.

CONCLUSIONS

The RFS outcomes may improve reminiscence-based interventions, since the functions of reminiscence are key players in older adults daily life.

CLINICAL IMPLICATIONS

Reminiscence-based interventions should promote positive memories, which are associated with improved well-being. Particularly, it seems a good practice when supporting older adults regarding critical and traumatic events.

The Effects of Exergaming on the Depressive Symptoms of People With Dementia: A Systematic Review and Meta-Analysis

BACKGROUND

Depressive symptoms are common among people with dementia (PWD). Exergaming consisting of combined cognitive and physical training in gaming is increasingly used to alleviate their depressive symptoms in research. With its potential synergistic neurobiological and psychosocial effects on reducing depressive symptoms among PWD, this review aimed to understand its effectiveness and contents.

METHODS

This is a systematic review of the effectiveness of exergames on depressive symptoms among older adults with dementia. A search was conducted on 7 May 2024 of the online databases CINAHL, Embase, PsycINFO, PubMed and the China Academic Journal Network Publishing Database (CNKI). The methodological quality of randomised controlled trials (RCT) and quasi-experimental studies was assessed with RoB2 and ROBINS-I, respectively. A meta-analysis of the included RCTs was conducted.

RESULTS

Six studies consisting of four RCTs and two quasi-experimental studies involving 235 participants with various stages of dementia were included. The meta-analysis showed a significant overall improvement in depression with a large effect size (SMD = 1.46, 95% CI = -2.50, -0.43; p = 0.006). Despite high heterogeneity (I2 = 91%), all studies demonstrated a trend of improvement in depression after the intervention. The exergames adopted in the included trials had the following elements: simultaneous motor-cognitive training, a scoring mechanism and a social play. The dose of exergames ranged from 15 to 60 min per session for at least 8 weeks, with a minimum of two sessions weekly. However, the included studies had a moderate-to-serious risk of bias. The certainty of the evidence was very low.

CONCLUSION

Exergames could be effective at improving the depressive symptoms of older adults with dementia. Yet, a moderate-to-severe risk of bias shows a rigorous study should be conducted in the future.

IMPLICATIONS FOR PATIENT CARE

This study provides evidence for healthcare professionals and informal caregivers to use exergames to address depressive symptoms in PWD.

REVIEW REGISTRATION

The review was registered on PROSPERO with the reference CRD42022372762.

Treatments for Depression for Older Adults Living in Long-Term Care: A Systematic Review and Network Meta-Analysis

OBJECTIVE

To assess the comparative efficacy of interventions on depressive symptoms and disorders in older adults living in long-term care (LTC).

DESIGN

Systematic review and network meta-analysis.

SETTING AND PARTICIPANTS

Older adults living in LTC or equivalent settings.

METHODS

We searched 6 electronic databases and gray literature sources to identify randomized controlled trials describing pharmacologic or nonpharmacologic interventions. Studies had to measure depression as an outcome in persons living in LTC. Study inclusion and study quality were assessed in duplicate. Population characteristics, descriptions of intervention and control treatments, and end-point depression outcomes for each treatment were extracted from included studies. A network meta-analysis using the standardized mean difference (SMD) of depression scores was completed using a random effects model.

RESULTS

A total of 182 studies were included in the review. The network meta-analysis was completed with 147 studies and included 31 treatment conditions. Compared with usual care, horticulture therapy (SMD, -6.85; 95% Credibility Interval, -8.49 to -5.22) and cognitive behavioral therapy (SMD, -1.98; 95% Credibility Interval, -2.91 to -1.05) were the most efficacious treatments. Animal therapy, group reminiscence therapy, multicomponent nonpharmacologic treatments, exercise, and socialization interventions also significantly improved depressive symptoms compared with usual care.

CONCLUSIONS AND IMPLICATIONS

Many nonpharmacologic treatments for depression in LTC have been studied and are found to be efficacious. The low-risk and cost-effective nature of many of the nonpharmacologic treatments makes them ideal for use in LTC. More studies of pharmacologic treatments are needed to inform prescribing for depression in the LTC population. The range of treatments available for depression may help clinicians select therapies individualized to resident needs.

A core capability framework for physiotherapists to deliver quality care when working with people living with dementia and their families/caregivers: an international modified e-Delphi study

OBJECTIVE

What are the core capabilities physiotherapists need to deliver quality care when working with people with dementia and their families/caregivers?

DESIGN

A three-round modified e-Delphi study.

PARTICIPANTS

Panel members were physiotherapists experienced in working with people with dementia and/or educating and/or researching in the dementia field.

METHODS

A steering group (16 international physiotherapists and a consumer) developed a draft framework including 129 core capabilities across 5 domains for panel members to rate their appropriateness for inclusion as a core capability to provide high quality care to people with dementia and their caregivers/families. The RAND/UCLA method was used to assess consensus.

RESULTS

Thirty-five physiotherapists from 11 countries participated in Round 1, 31 (89%) in Round 2 and 28 (80% of Round 1) in Round 3. All core capabilities were rated appropriate for inclusion in each round. Panel members recommended wording refinements across the rounds and suggested 51 core capabilities for consideration. Three rounds were needed to reach consensus, resulting in 137 core capabilities rated appropriate for inclusion across 5 domains: 1) Knowledge and understanding, n = 36; 2) Assessment, n = 39; 3) Management, interventions and prevention n = 40; 4) Communication, therapeutic relationship and person-centred care, n = 17; and 5) Physiotherapists self-management and improvement, n = 5.

CONCLUSIONS

This e-Delphi study outlines the core capabilities physiotherapists need to provide high quality care to people with dementia and their families/caregivers. These core capabilities can be used by physiotherapists to help identify knowledge/skill gaps, as well as by educators to improve their training of undergraduate and postgraduate students, and clinicians. CONTRIBUTION OF PAPER.

Evaluating the effectiveness of integrated traditional Chinese and Western treatment based on symptom grading: a study protocol for a multi-center, randomized controlled trial of patients with depressive disorder

Background

Approximately one-third of depressed individuals receive treatment globally. The application rate of traditional Chinese medicine (TCM) for treating depression globally remains relatively low. The proposed study presents a pilot trial to evaluate the effectiveness of interventions at different levels in improving depression status in community populations.

Methods

A randomized controlled trial will be conducted in two communities in Guangdong, China, with a follow-up period of 12 weeks. Participants will be randomly allocated to control or intervention groups. Participants in the control group will be assigned to routine care, while participants in the intervention group will receive TCM intervention measures. The participants in the intervention group will receive integrated traditional Chinese and Western treatment according to the symptom grading of depression severity. Primary outcome measurements include the Patient Health Questionnaire (PHQ-9), the Hamilton Depression Rating Scale (HAMD-17), and the Self-Rating Depression Scale (SDS). Secondary outcome measurements include the Athens Insomnia Scale (AIS), the Epworth Sleepiness Scale (ESS), the Multiple Mental Health Literacy Scale (MMHL), the Short-Form 12 (SF-12), and the Treatment Emergent Symptom Scale (TESS). The data will be collected at baseline (T1), 2 weeks after intervention (T2), 4 weeks after intervention (T3), 8 weeks after intervention (T4), and 12 weeks after intervention (T5).

Discussion

This study will provide an experimental basis for the effectiveness of hierarchical integrated traditional Chinese and Western medicine (ITCWM) in improving the condition of patients with different degrees of depression. At the end of the study, it is expected for the experimental group to have an improvement in depressive symptoms and sleep quality and an enhancement in mental health awareness.

Clinical trial registration

http://www.chictr.org.cn, identifier ChiCTR2300075169.

The effect of cognitive stimulation therapy on daily life activities, depression and life satisfaction of older adults living with dementia in nursing home: Randomized controlled trial

OBJECTIVES

In this research, it was aimed to evaluate the effects of Cognitive Stimulation Therapy on activities of daily living, depression, and life satisfaction in older adults with dementia in nursing homes.

METHODS

It is a randomized controlled experimental study. The study consisted of a total of 60 older adults, 30 in the intervention group and 30 in the control group, in two different nursing homes.

RESULTS

In the post-CST comparison, BADLI posttest measurements, IADLS posttest, follow-up test measurements (p < .001, Fr = 45.982, Fr = 42.54) and SWLS posttest (p < .001, Fr = 38.47) of the individuals in the intervention group measurements were significantly higher. The mean depression level of the CSDD posttest and follow-up test intervention group was significantly lower (p < .001, F = 0.402).

CONCLUSION

It was found that Cognitive Stimulation Therapy is effective in increasing the levels of daily life activity and life satisfaction and reducing the level of depression in older adults with dementia. It is recommended to be used by psychiatric nurses.

Efficacy and safety of Neurocognitive Adaptive Training for Depression combined with SSRIs for treating cognitive impairment among patients with late-life depression: a 12-week, randomized controlled study

BACKGROUND

This randomized, open-label study examined the therapeutic effects of Neurocognitive Adaptive Training for Depression (NCAT-D) combined with selective serotonin reuptake inhibitors (SSRIs) on cognitive impairment among patients with late-life depression (LLD).

METHOD

Study data were collected from May 5, 2021, to April 21, 2023. Outpatients who met the diagnostic criteria for major depressive disorder according to the fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (i.e., a total score on the 17-item Hamilton Depression Rating Scale (HAMD-17) ≥ 18 and a total score on the Montreal Cognitive Assessment scale (MOCA) < 26) were recruited at Beijing Anding Hospital. These participants were randomly assigned to receive up to 12 weeks of NCAT-D and SSRIs treatment (n = 57) or SSRIs with a control treatment (n = 61). Primary outcomes included changes in Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) scores from baseline to week 12 between the two groups. Assessments were conducted at baseline, after 2 weeks, 4 weeks, 8 weeks, and at 12 weeks. Mixed model repeated measures (MMRM) analysis was performed on modified intention-to-treat (mITT) and completer populations.

RESULTS

The full analysis set (FAS) included 118 patients (NCAT-D and SSRIs group, n = 57; SSRIs and Control group, n = 61). During the 12-week study period, MMRM analysis revealed a significantly greater reduction in cognitive function (as indicated by ADAS-cog total scores) from baseline to post-treatment in the NCAT-D and SSRIs group compared to the SSRIs and Control groups [(F (1,115) = 13.65, least-squares mean difference [95% CI]: -2.77 [- 3.73, - 1.81], p < 0.001)]. The intervention group showed a significantly greater reduction in HAMD-17 scores compared to the control group [MMRM, estimated mean difference (SE) between groups: -3.59 [- 5.02, - 2.15], p < 0.001]. There was no significant difference in the incidence of adverse events between the two groups.

CONCLUSIONS

NCAT-D combined with SSRIs was efficacious and well tolerated in LLD patients with cognitive impairment.

TRIAL REGISTRATION

Registered on October 18, 2022, at ClinicalTrials.gov Identifier: (#NCT05588102).

Dementia

Dementia, or major neurocognitive disorder, is defined as a decline in 1 or more cognitive domains that causes impairment in everyday function. Alzheimer disease is the most common type of dementia in the United States, with an estimated 6.9 million adults who have Alzheimer disease and are 65 years or older. This article discusses the latest findings in preventing cognitive decline. It also discusses dementia screening, diagnosis, treatment, and the quality of life for persons with dementia and their caregivers.

Depression detection in dementia: A diagnostic accuracy systematic review and meta analysis update

Background

Depression is common in persons with dementia and is often under-detected and under-treated. It is critical to understand which available tools accurately detect depression in the context of dementia.

Methods

We updated our systematic review completed in 2015. The search strategy of our original review was replicated in Medline, Embase, and PsycINFO. Studies describing the use of a tool to identify depression in persons with dementia, compared to a criterion standard, and reporting diagnostic accuracy outcomes were included in the review update. Pooled prevalence estimates of major depression and pooled estimates of diagnostic accuracy outcomes (i.e., sensitivity [SN], specificity [SP]) for tools were calculated.

Results

Three studies were included of the 8980 returned from the database search and were added to the prior 20 articles from the 2015 review. The Cornell Scale for Depression in Dementia (CSDD), Geriatric Depression Scale (GDS)-15 item, Neuropsychiatric Inventory-Depression items (NPI-D), and Depression in Old Age Scale (DIA-S) were evaluated in the three studies. Two new studies were added to the existing pooled prevalence estimate of major depression (29%, 95% confidence interval [CI] = 21.6%-36.5%, n = 17) and pooled diagnostic accuracy estimate for the CSDD at the best cut-off (SN = 0.83, 95% CI = 0.74-0.90; SP = 0.81, 95% CI = 0.69-0.89). New pooled diagnostic accuracy estimates were completed for the CSDD (cut-off ≥12) (SN = 0.61, 95% CI = 0.42-0.77; SP = 0.83, 95% CI = 0.76-0.88), GDS-15 (best cut-off) (SN = 0.65, 95% CI = 0.40-0.83; SP = 0.72, 95% CI = 0.55-0.85), and Montgomery Asberg Depression Rating Scale (MADRS) (best cut-off) (SN = 0.77, 95% CI = 0.67-0.85; SP = 0.68, 95% CI = 0.60-0.75).

Conclusions

The CSDD continues to have the most evidence for depression case finding in persons living with dementia. The CSDD and Hamilton Depression Rating Scale have the highest sensitivities and may be recommended for use over other common tools like the GDS-15 and MADRS. Newly identified tools like the NPI-D and DIA-S require further study before they can be recommended for use in practice.

Psychological treatments for mental health symptoms associated with COVID-19 infection: A scoping review

The aim of this scoping review was to synthesize published studies and ongoing clinical trials of psychological interventions for mental health problems associated with COVID-19 infection. The study protocol was developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews. We conducted systematic searches for studies published or registered between January 2020 and October 2022 using eight scientific databases and clinical trial registries, which identified 40 complete published studies and 53 ongoing clinical trials. We found that most studies were randomized controlled trials (74%) while the remaining used study designs of lower methodological quality. Most studies investigated interventions for acute COVID-19 patients (74%) and others explored post-COVID conditions (PCC) or recovered patients. Cognitive and behavioral therapies were the main intervention approaches (31%), followed by multidisciplinary programs (21%) and mindfulness (17%). The most frequently evaluated outcomes were anxiety (33%), depression (26%), quality of life (13%), and insomnia (10%). No studies on youths, older people, or marginalized communities were found. These findings summarize the burgeoning research on a range of psychological interventions for individuals infected with COVID-19. However, the field is in its infancy and further research to develop an evidence base for targeted care is necessary. The gaps identified in the current study also highlight the need for more research on youths, older people, and members of marginalized communities, and PCC patients. It is important to ascertain interventions and delivery strategies that are not only effective and affordable but also allow high scalability and accessibility.

The Effect of Walking on Depressive and Anxiety Symptoms: Systematic Review and Meta-Analysis

Background

Previous literature lacks summative information on the mental health benefits achieved from different forms of walking.

Objective

The aim of this study was to assess the effectiveness of different forms of walking in reducing symptoms of depression and anxiety.

Methods

This was a systematic review and meta-analysis of randomized controlled trials (RCTs) assessing the effects of walking on depressive and anxiety symptoms. MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, PsycINFO, Allied and Complementary Medicine Database (AMED), CINAHL, and Web of Science were searched on April 5, 2022. Two authors independently screened the studies and extracted the data. Random-effects meta-analysis was used to synthesize the data. Results were summarized as standardized mean differences (SMDs) with 95% CIs in forest plots. The risk of bias was assessed by using the Cochrane Risk of Bias tool.

Results

This review included 75 RCTs with 8636 participants; 68 studies reported depressive symptoms, 39 reported anxiety symptoms, and 32 reported both as the outcomes. One study reported the results for adolescents and was not included in the meta-analysis. The pooled results for adults indicated that walking could significantly reduce depressive symptoms (RCTs: n=44; SMD -0.591, 95% CI -0.778 to -0.403; I2=84.8%; τ2=0.3008; P<.001) and anxiety symptoms (RCTs: n=26; SMD -0.446, 95% CI -0.628 to -0.265; I2=81.1%; τ2=0.1530; P<.001) when compared with the inactive controls. Walking could significantly reduce depressive or anxiety symptoms in most subgroups, including different walking frequency, duration, location (indoor or outdoor), and format (group or individual) subgroups (all P values were <.05). Adult participants who were depressed (RCTs: n=5; SMD -1.863, 95% CI -2.764 to -0.962; I2=86.4%; τ2=0.8929) and those who were not depressed (RCTs: n=39; SMD -0.442, 95% CI -0.604 to -0.280; I2=77.5%; τ2=0.1742) could benefit from walking effects on their depressive symptoms, and participants who were depressed could benefit more (P=.002). In addition, there was no significant difference between walking and active controls in reducing depressive symptoms (RCTs: n=17; SMD -0.126, 95% CI -0.343 to 0.092; I2=58%; τ2=0.1058; P=.26) and anxiety symptoms (14 RCTs, SMD -0.053, 95% CI -0.311 to 0.206, I2=67.7%, τ2=0.1421; P=.69).

Conclusions

Various forms of walking can be effective in reducing symptoms of depression and anxiety, and the effects of walking are comparable to active controls. Walking can be adopted as an evidence-based intervention for reducing depression and anxiety. More evidence on the effect of low-intensity walking is needed in the future.

Effects of non-pharmacological interventions for adults with subjective cognitive decline: a network meta-analysis and component network meta-analysis

BACKGROUND

Non-pharmacological interventions have a myriad of available intervention options and contain multiple components. Whether specific components of non-pharmacological interventions or combinations are superior to others remains unclear. The main aim of this study is to compare the effects of different combinations of non-pharmacological interventions and their specific components on health-related outcomes in adults with subjective cognitive decline.

METHODS

PubMed, Embase, Cochrane, CINAHL, PsycINFO, CENTRAL, Web of Science, and China's two largest databases, CNKI and Wanfang, were searched from inception to 22nd, January 2023. Randomized controlled trials using non-pharmacological interventions and reporting health outcomes in adults with subjective cognitive decline were included. Two independent reviewers screened studies, extracted data, and assessed risk of bias. Component network meta-analysis was conducted employing an additive component model for network meta-analysis. This study followed the PRISMA reporting guideline and the PRISMA checklist is presented in Additional file 2.

RESULTS

A total of 39 trials with 2959 patients were included (range of mean ages, 58.79-77.41 years). Resistance exercise might be the optimal intervention for reducing memory complaints in adults with subjective cognitive decline; the surface under the cumulative ranking p score was 0.888, followed by balance exercise (p = 0.859), aerobic exercise (p = 0.832), and cognitive interventions (p = 0.618). Music therapy, cognitive training, transcranial direct current stimulation, mindfulness therapy, and balance exercises might be the most effective intervention components for improving global cognitive function (iSMD, 0.83; 95% CI, 0.36 to 1.29), language (iSMD, 0.31; 95% CI, 0.24 to 0.38), ability to perform activities of daily living (iSMD, 0.55; 95% CI, 0.21 to 0.89), physical health (iSMD, 3.29; 95% CI, 2.57 to 4.00), and anxiety relief (iSMD, 0.71; 95% CI, 0.26 to 1.16), respectively.

CONCLUSIONS

The form of physical activity performed appears to be more beneficial than cognitive interventions in reducing subjective memory complaints for adults with subjective cognitive decline, and this difference was reflected in resistance, aerobic, and balance exercises. Randomized clinical trials with high-quality and large-scale are warranted to validate the findings.

TRIAL REGISTRATION

PROSPERO registry number. CRD42022355363.

Comparative efficacy of multiple non-pharmacological interventions for behavioural and psychological symptoms of dementia: A network meta-analysis of randomised controlled trials

Non-pharmacological interventions can improve the behavioural and psychological symptoms of dementia (BPSD). However, the optimal non-pharmacological treatments remain controversial. This study aimed to compare the efficacy of multiple non-pharmacological methods and identify the optimal therapy for BPSD. Potential randomised controlled trials (RCTs) were searched and selected from 15 databases and sources from the inception of the databases until 1 October 2022. Two independent authors implemented study screening, data extraction, and methodological quality assessment. Primary outcome was reduction of Neuropsychiatric Inventory (NPI). The secondary outcome were changes of Cornell Scale for Depression in Dementia (CSDD), the Cohen-Mansfield Agitation Inventory (CMAI), the Quality of Life in Alzheimer's Disease (QoL-AD), the Abilities of Daily Living scale, and the Apathy Evaluation Scale. Meta-analyses were performed using STATA v15.0 and ADDIS v1.16.8. The GRADE approaches were utilised to evaluate evidence quality. The present study included 43 RCTs with 4978 participants. The global methodological quality of the RCTs was moderate. Regarding NPI reduction, with moderate-certainty evidence, exercise plus treatment as usual (TAU) outperformed TAU (mean difference [MD]: -7.13; 95% confidence interval [CI]: -13.22, -0.76) and ranked as the optimal treatment. For reduction in CSDD, with low- to moderate-certainty evidence, massage plus TAU (MD: -15.26; 95% CI: -20.13, -10.52) and music plus TAU (MD: -2.40; 95% CI: -4.62, -0.12) were associated with greater reduction compared with TAU. For reduction in CMAI, with moderate-certainty evidence, aromatherapy plus massage (MD: -15.84; 95% CI: -29.76, -2.42) and massage plus music (MD: -13.12; 95% CI: -25.43, -0.76) were significantly more effective than TAU. For improvement in QoL-AD, with critically low- to low-certainty evidence, there were no statistical differences between any of non-pharmacological treatments and TAU. Due to the limited number of included studies, network meta-analysis was not performed for other outcomes. In conclusion, non-pharmacological treatments are effective for overall symptoms, depression, and agitation. Exercise plus treatment as usual may be an optimal non-pharmacological intervention for improving the overall BPSD. This may help to guide patients, doctors, and policymakers.

Depression in Alzheimer's Disease: Epidemiology, Mechanisms, and Treatment

Depression and Alzheimer's disease (AD) are substantial public health concerns. In the past decades, a link between the 2 disease entities has received extensive acknowledgment, yet the complex nature of this relationship demands further clarification. Some evidence indicates that midlife depression may be an AD risk factor, while a chronic course of depression in late life may be a precursor to or symptom of dementia. Recently, multiple pathophysiological mechanisms have been proposed to underlie the bidirectional relationship between depression and AD, including genetic predisposition, immune dysregulation, accumulation of AD-related biomarkers (e.g., amyloid-β and tau), and alterations in brain structure. Accordingly, numerous therapeutic approaches, such as pharmacology treatments, psychotherapy, and lifestyle interventions, have been suggested as potential means of interfering with these pathways. However, the current literature on this topic remains fragmented and lacks a comprehensive review characterizing the association between depression and AD. In this review, we aim to address these gaps by providing an overview of the co-occurrence and temporal relationship between depression and AD, as well as exploring their underlying mechanisms. We also examine the current therapeutic regimens for depression and their implications for AD management and outline key challenges facing the field.

Factors promoting and impeding efforts to deprescribe antidepressants among nursing home residents with dementia- a process evaluation guided by normalization process theory

BACKGROUND

Despite recommendations against psychotropic medication in older nursing homes residents with behavioral and psychological symptoms of dementia (BPSD), antidepressants and other psychotropic drugs are still prescribed. We performed a cluster-randomized controlled trial to evaluate the effect of a complex intervention aiming to promote the deprescribing of antidepressants in institutionalized older persons with dementia. To understand the underlying mechanisms of trial outcomes, we conducted a process evaluation exploring the interventions implementation, areas of impact, and contextual factors. The aim of this study was to explore the implementation process and the key factors that promoted and inhibited intervention implementation in the care home setting (Clinicaltrials.gov: NCT04985305. Registered 30 July 2021).

METHODS

Qualitative interviews were conducted between August 2022 and February 2023 with four general practitioners and eight nursing home staff from four associated nursing homes in the Capital Region of Denmark. We coded the interview data according to the four constructs of the Normalization Process Theory (coherence, cognitive participation, collective action, and reflexive monitoring).

RESULTS

There was a common understanding of the intervention aim. We observed a raised awareness concerning the deprescription of antidepressants among healthcare professionals with good collaboration (coherence). An overall buy-in to a deprescribing mentality was seen (cognitive participation). There were barriers to the GPs and nursing home staff's use of the intervention elements and how they implemented it, but to some, a common language was created (collective action). Professionals overall valued the idea of deprescribing, but lack of time, high staff turnover, and low education level among nursing home staff hampered the integration (reflexive monitoring).

CONCLUSION

Successful implementation seemed to be dependent on the quality of the relationship between the single GP and the single nursing home professional. A common deprescribing mentality promoted the uptake of the intervention. However, several barriers related to lack of resources hindered implementation. It is imperative to adapt complex interventions to the available resources and context.

Effectiveness of Non-Pharmacological Interventions for Dementia among the Elderly: A Randomized Controlled Trial

(1) Background: Up until now, there is still no medicine that can cure dementia, but there are some that can only help slow down the progression of the disease and reduce some symptoms. Pharmacological interventions for dementia have many side effects and are expensive, so non-pharmacological treatments for dementia become more urgent. This study aimed to evaluate the effectiveness of multifactorial non-pharmacological interventions in dementia patients; (2) Methods: This is a randomized controlled trial conducted in Hai Duong from July 2021 to December 2022. Selected subjects included 88 patients diagnosed with very mild, mild, and moderate dementia, of whom 44 patients were assigned to the intervention group and 44 patients to the control group; (3) Results: For the effectiveness of the non-pharmacological multifactorial intervention on depression severity: in the intervention group, the GDS 15 depression score decreased from 4.8 to 2.9, while, in the control group, the GDS 15 depression score increased by 1.3 points after six months of no intervention. For the effect of the non-pharmacological multifactorial intervention on the level of sleep disturbance, in the intervention group, the PSQI sleep disturbance score decreased by nearly half (from 10.2 to 5.6), while, in the control group, this trend was not clear. For the effect of the non-pharmacological multifactorial intervention on daily functioning: in the intervention group, the ADL and IADL scores improved (1.02 ± 1.32 and 1.23 ± 1.75), while, in the control group, the ADL and IADL scores decreased (0.93 ± 1.2 and 0.98 ± 2.19). For the effect of the non-pharmacological multifactorial intervention on quality of life: in the intervention group, the EQ-5D-5L scores improved (0.17 ± 0.19), while, in the control group, the EQ-5D-5L scores decreased (0.20 ± 0.30); (4) Conclusions: Non-pharmacological multifactorial interventions, including physical activity, cognitive training, listening to educational lectures, and organizing miniature social models, have been shown to improve mental health, self-control, and quality of life.

North Macedonia interprofessional dementia care (NOMAD) - personalized care plans for people with dementia and caregiver psychoeducation delivered at home by interprofessional teams

Introduction

The increasing number of people living with dementia and its burden on families and systems particularly in low- and middle-income countries require comprehensive and efficient post-diagnostic management. This study aimed to explore the acceptability and efficacy of a multi-professional case management and psychoeducation model (North Macedonia Interprofessional Dementia Care, or NOMAD) delivered by mobile teams for people with dementia and their caregivers in North Macedonia.

Method

We conducted a two-arm randomized controlled trial comparing the intervention with treatment as usual. Participants were recruited from 12 general practitioner (GP) offices in the Skopje region. The NOMAD intervention included the delivery of a personalized care plan over four home visits to dyads of people with dementia and their caregivers by a team including a dementia nurse and a social worker, in collaboration with GPs and dementia experts, and the introduction of a caregiver manual. We assessed caregivers' depressive symptoms, burden, and quality of life and the neuropsychiatric symptoms, daily living activities, and service utilization of people with dementia at baseline and follow-up; we also assessed the acceptability of the intervention by analyzing case notes and attendance rates.

Results

One hundred and twenty dyads were recruited and randomized to either the control (n = 60) or the intervention group (n = 60). At follow-up, caregivers in the intervention group had, on average, scores that were 2.69 lower for depressive symptoms (95% CI [-4.75, -0.62], p = 0.012), and people with dementia had, on average, 11.32 fewer neuropsychiatric symptoms (95% CI [-19.74, -2.90], p = 0.009) and used, on average, 1.81 fewer healthcare services (95% CI [-2.61, -1.00], p < 0.001) compared to the control group. The completion of the home visits was 100%, but the intervention's acceptability was underpinned by relationship building, GP competencies, and resources to support families with dementia. There were no differences in the caregivers' quality of life and burden levels or daily living activities in people with dementia. NOMAD is the first case management, non-pharmacological, and multi-professional intervention tested in North Macedonia.

Discussion

The trial showed that it is effective in reducing caregivers' depressive symptoms and neuropsychiatric symptoms in people with dementia and the burden on health and social care services, and it is acceptable for families. Implementing NOMAD in practice will require building primary care capacity and recognizing dementia as a national priority.

Risk of depression in persons with Alzheimer's disease: A national cohort study

INTRODUCTION

Depression is a risk factor and possible prodromal symptom of Alzheimer's disease (AD), but little is known about subsequent risk of developing depression in persons with AD.

METHODS

National matched cohort study was conducted of all 129,410 persons diagnosed with AD and 390,088 with all-cause dementia during 1998-2017 in Sweden, and 3,900,880 age- and sex-matched controls without dementia, who had no prior depression. Cox regression was used to compute hazard ratios (HRs) for major depression through 2018.

RESULTS

Cumulative incidence of major depression was 13% in persons with AD and 3% in controls. Adjusting for sociodemographic factors and comorbidities, risk of major depression was greater than two-fold higher in women with AD (HR, 2.21; 95% confidence interval [CI], 2.11-2.32) or men with AD (2.68; 2.52-2.85), compared with controls. Similar results were found for all-cause dementia.

DISCUSSION

Persons diagnosed with AD or related dementias need close follow-up for timely detection and treatment of depression.

Highlights

In a large cohort, women and men with AD had >2-fold subsequent risk of depression.Risks were highest in the first year (>3-fold) but remained elevated ≥3 years later.Risk of depression was highest in persons aged ≥85 years at AD diagnosis.Persons with AD need close follow-up for detection and treatment of depression.

Adapted problem adaptation therapy for depression in mild to moderate Alzheimer's disease dementia: A randomized controlled trial

INTRODUCTION

Trials of effectiveness of treatment options for depression in dementia are an important priority.

METHODS

Randomized controlled trial to assess adapted Problem Adaptation Therapy (PATH) for depression in mild/moderate dementia caused by Alzheimer's disease.

RESULTS

Three hundred thirty-six participants with mild or moderate dementia, >7 on Cornell Scale for Depression in Dementia (CSDD), randomized to adapted PATH or treatment as usual. Mean age 77.0 years, 39.0% males, mean Mini-Mental State Examination 21.6, mean CSDD 12.9. For primary outcome (CSDD at 6 months), no statistically significant benefit with adapted PATH on the CSDD (6 months: -0.58; 95% CI -1.71 to 0.54). The CSDD at 3 months showed a small benefit with adapted PATH (-1.38; 95% CI -2.54 to -0.21) as did the EQ-5D (-4.97; 95% CI -9.46 to -0.48).

DISCUSSION

An eight-session course of adapted PATH plus two booster sessions administered within NHS dementia services was not effective treatment for depression in people with mild and moderate dementia. Future studies should examine the effect of more intensive and longer-term therapy.

Comparative efficacy of interventional therapies and devices for coronary in-stent restenosis: A systematic review and network meta-analysis of randomized controlled trials

Background

In-stent restenosis (ISR) has become a significant obstacle to interventional therapy for atherosclerotic cardiovascular disease. The optimal percutaneous coronary intervention (PCI) strategy for patients with coronary ISR remains controversial. This network meta-analysis (NMA) was aimed to compare and estimate the effectiveness of different PCI strategies and commercial devices for the treatment of patients with coronary ISR.

Methods

In present study, we systematically searched PubMed, Embase, Web of Science, and Cochrane Library from database inception to October 20, 2022, to identify randomized controlled trials. We included studies comparing various PCI strategies for the treatment of any type of coronary ISR. The study was registered with PROSPERO, CRD 42022364308.

Results

We included 44 eligible trials including 8479 patients, 39 trials comparing the treatment effects of 10 PCIs, and 5 trials comparing the efficacy between different types of drug-eluting stent (DES) or drug-coated balloon (DCB) devices. Among the PCIs, everolimus-eluting stent was the optimal strategy considering target lesion revascularization (TLR), percent diameter stenosis (%DS), and binary restenosis (BR), and sirolimus-coated balloon was the optimal strategy considering late lumen loss (LLL). In the comparison of commercial devices, the combination strategy excimer laser coronary angioplasty plus SeQuent Please paclitaxel-coated balloon showed promising therapeutic prospects.

Conclusions

DCB and DES remain the preferred treatment strategies for coronary ISR, considering both the primary clinical outcome (TLR) and the angiographic outcomes (LLL, BR, %DS). Personalized combination interventions including DCB or DES hold promise as a novel potential treatment pattern for coronary ISR.

Traditional Pediatric Massage Enhanced Hippocampal GR, BDNF and IGF-1 Expressions and Exerted an Anti-depressant Effect in an Adolescent Rat Model of CUMS-induced Depression

This study aimed to investigate the anti-depressant effect of traditional pediatric massage (TPM) in adolescent rats and its possible mechanism. The adolescent depression model in rats was established by using chronic unpredictable mild stress (CUMS). All rats were randomly divided into five groups (seven per group), including the groups of control (CON), CUMS, CUMS with TPM, CUMS with back stroking massage (BSM) and CUMS with fluoxetine (FLX). The tests of sucrose preference, Morris water maze and elevated plus maze were used to evaluate depression-related behaviors. Plasma corticosterone (CORT) level was measured by ELISA. The gene and protein expressions of glucocorticoid receptor (GR), brain-derived neurotrophic factor (BDNF) and insulin-like growth factor-1 (IGF-1) were measured by RT-qPCR and IHC respectively. The results showed that CUMS induced depression-related behaviors in the adolescent rats, along with decreased weight gain and reduced hippocampal expressions of GR, IGF-1 and BDNF. TPM could effectively prevent depression-related behaviors in CUMS-exposed adolescent rats, manifested as increasing weight gain, sucrose consumption, ratio of open-arm entry, times of crossing the specific quadrant and shortening escape latency. TPM also decreased CORT level in plasma, together with enhancing expressions of GR, IGF-1 and BDNF in the hippocampus. These results may support the clinical application of TPM to prevent and treat adolescent depression.

Association of depressive symptoms and dementia among middle-aged and elderly community-dwelling adults: Results from the China Health and Retirement Longitudinal Study (CHARLS)

BACKGROUND

There has been a long-standing debate on whether depressive symptoms are associated with dementia. The aim of this study was to examine whether depressive symptoms were associated with a high risk for dementia in Chinese adults.

METHODS

A total of 13,426 Chinese adults (≥45 years old) from the China Health and Retirement Longitudinal Study (CHARLS) baseline were selected for analysis. Depressive symptoms were assessed by the Center for Epidemiologic Studies Depression Scale (CESD-10). Dementia was assessed by the Community Screening Instrument for Dementia (CSI-D). When using linear regression for sensitivity analysis, there is still a correlation between depressive symptoms and dementia.

RESULTS

Of the 13,426 respondents, the mean (SD) age was 60 (10) years old. The prevalence of depressive symptoms and dementia among participants was 38 % (n = 945) and 18.3 % (n = 2457), respectively. After fully adjusted for demographic factors, health behavior and psychological factors, living and working conditions factors, social network factors, and social policy factors, the cross-sectional analyses showed that depressive symptoms had an increased risk of dementia (OR = 1.390, 95%CI: 1.253-1.543), compared with those without depressive symptoms. In addition, sensitivity analyses of the association between depressive symptoms and dementia were unchanged when reanalyzing using linear regression.

CONCLUSIONS

In this study, depression symptoms may be associated with dementia. Regardless of whether depressive symptoms acts as a dementia risk factor or an early symptom, monitoring depressive symptoms is crucial to watch for potential dementia onset.

Clinical effectiveness of pharmacological and non-pharmacological treatments for the management of anxiety in community dwelling people living with dementia: A systematic review and meta-analysis

People living with dementia commonly experience anxiety, which is often challenging to manage. We investigated the effectiveness of treatments for the management of anxiety in this population. We conducted a systematic review and meta-analysis of randomised controlled trials, and searched EMBASE, CINAHL, MEDLINE and PsycInfo. We estimated standardised mean differences at follow-up between treatments relative to control groups and pooled these across studies using random-effects models where feasible. Thirty-one studies were identified. Meta-analysis demonstrated non-pharmacological interventions were effective in reducing anxiety in people living with dementia, compared to care as usual or active controls. Specifically, music therapy (SMD-1.92(CI:-2.58,-1.25)), muscular approaches (SMD-0.65(CI:-1.02,-0.28)) and stimulating cognitive and physical activities (SMD-0.31(CI:-0.53,-0.09)). Pharmacological interventions with evidence of potential effectiveness included Ginkgo biloba, probiotics, olanzapine, loxapine and citalopram compared to placebo, olanzapine compared to bromazepam and buspirone and risperidone compared to haloperidol. Meta-analyses were not performed for pharmacological interventions due to studies' heterogeneity. This has practice implications when promoting the use of more non-pharmacological interventions to help reduce anxiety among people living with dementia.

Predictors of live-in migrant caregiver employment for people with dementia in Taiwan

BACKGROUND

With the increasing number of individuals with dementia, families have hired an increasing number of live-in migrant caregivers (LIMCs). Currently, limited evidence is available regarding the influence of long-term care resource utilization on the hiring of LIMCs for caring for individuals with dementia in Taiwan.

METHODS

We recruited individuals with dementia who did not hire LIMCs and their primary family caregivers from nine hospitals in Taiwan as baseline. Multivariable logistic regression was used to evaluate the utilization of long-term care resources for individuals with dementia and other factors that may affect the decision to hire LIMCs.

RESULTS

The users of non-long-term care resources had the highest likelihood of hiring LIMCs (odds ratio [OR] = 4.24, 95% CI, 2.30-7.84). Compared with spouses, nonimmediate family caregivers (OR = 3.40, 95% CI, 1.16-9.90) were significantly more likely to hire LIMCs. A higher likelihood of hiring LIMCs was observed for those with Lewy body dementia compared with other individuals (OR = 2.31, 95% CI, 1.03-5.14). Compared with individuals who did not hire LIMCs, those who hired LIMCs exhibited higher scores on the Neuropsychiatric Inventory (NPI) and higher severity of individual NPI items.

CONCLUSION

Hiring LIMCs is strongly correlated with the utilization of non-long-term care resources and is influenced by the dynamics between individuals with dementia and their primary family caregivers. A higher likelihood of hiring LIMCs was observed for individuals with Lewy body dementia and individuals with elevated NPI scores compared with their counterparts. Given these observations, various support strategies and interventions should be tailored to the specific requirements of individuals with dementia and their families.

Effects of non-pharmacological interventions on youth with internet addiction: a systematic review and meta-analysis of randomized controlled trials

Objective

To assess the overall effectiveness of non-pharmacological interventions on internet addiction (IA) in youth.

Method

Randomized controlled trials (RCTs) published from their inception to April 1, 2023 were searched in Cochrane, Embase, Medline, Web of Science, China National Knowledge Infrastructure, China Science and Technology Journal Database, Chinese BioMedical Literature Database, and WanFang Data. Two reviewers independently extracted data and evaluated bias using the Cochrane Risk of Bias tool.

Results

Sixty-six studies performed from 2007 to 2023, with a total of 4,385 participants, were identified. The NPIs included group counseling, cognitive behavioral therapy, sports intervention, combined interventions, eHealth, educational intervention, positive psychology intervention, sand play intervention, and electrotherapy. The results revealed that NPIs significantly reduced IA levels (standardized mean difference, SMD: -2.01, 95% confidence interval, CI: -2.29 to -1.73, I2 = 93.0%), anxiety levels (SMD: -1.07, 95%CI: -1.41 to -0.73, I2 = 72.4%), depression levels (SMD: -1.11, 95%CI: -1.52 to -0.7, I2 = 84.3%), and SCL-90 (SMD: -0.75, 95%CI: -0.97 to -0.54, I2 = 27.7%). Subgroup analysis stratified by intervention measure showed that cognitive behavioral therapy, group counseling, sports intervention, combined intervention, educational intervention, positive psychology intervention, sandplay intervention, and mobile health were all effective in relieving symptoms of IA except electrotherapy.

Conclusion

NPIs appear to be effective in the treatment of IA in youth, which would act as an alternative treatment of IA. Further studies with larger sample sizes and robust designs are needed.

Distinguishing features of depression in dementia from primary psychiatric disease

Depression is a common and devastating neuropsychiatric symptom in the elderly and in patients with dementia. In particular, nearly 80% of patients with Alzheimer's Disease dementia experience depression during disease development and progression. However, it is unknown whether the depression in patients with dementia shares the same molecular mechanisms as depression presenting as primary psychiatric disease or occurs and persists through alternative mechanisms. In this review, we discuss how the clinical presentation and treatment differ between depression in dementia and as a primary psychiatric disease, with a focus on major depressive disorder. Then, we hypothesize several molecular mechanisms that may be unique to depression in dementia such as neuropathological changes, inflammation, and vascular events. Finally, we discuss existing issues and future directions for investigation and treatment of depression in dementia.

Effectiveness, acceptability, and completeness and quality of intervention reporting of psychological interventions for people with dementia or mild cognitive impairment: protocol for a mixed-methods systematic review

INTRODUCTION

Mental health difficulties such as anxiety and depression have negative impacts on psychological well-being and are common in people with dementia and mild cognitive impairment. However, access to psychological treatments is limited. This mixed-method systematic review will: (1) examine the effectiveness of psychological interventions to improve mental health and psychological well-being in people with dementia or mild cognitive impairment; (2) examine the effectiveness of these psychological interventions to improve mental health and psychological well-being in informal caregivers; (3) examine potential clinical and methodological moderators associated with effectiveness; (4) explore factors associated with the acceptability of psychological interventions from the perspective of key stakeholders; and (5) examine the completeness and quality of intervention reporting.

METHODS AND ANALYSIS

Electronic databases (ASSIA, CENTRAL, CINAHL, EMBASE, PsycINFO and MEDLINE) will be systematically searched and supplemented with expert contact, reference and citation checking, and grey literature searches. If possible, we will conduct a meta-analysis to examine the overall effectiveness of psychological interventions to improve mental health and psychological well-being in people with dementia or mild cognitive impairment and their informal caregivers; and examine potential clinical and methodological moderators associated with effectiveness. We will conduct a deductive framework synthesis, informed by the theoretical framework of acceptability, to explore factors associated with the acceptability of psychological interventions from the perspective of key stakeholders. In accordance with Joanna Briggs Institute guidance, we will adopt a convergent segregated approach to data synthesis and integration of quantitative and qualitative findings. We will examine the completeness and quality of intervention reporting according to the Template for Intervention Description and Replication checklist and guide.

ETHICS AND DISSEMINATION

No primary data will be collected, and therefore, ethical approval is not required. Results will be disseminated through a peer-reviewed publication, academic conferences, and plain language summaries.

PROSPERO REGISTRATION NUMBER

CRD42023400514.

Healthcare and community stakeholders' perceptions of barriers and facilitators to implementing a behavioral activation intervention for people with dementia and depression: a qualitative study using Normalization Process Theory

BACKGROUND

Depression is commonly experienced by people with dementia, and associated with lower quality of life and functional decline. However, access to evidence-based psychological interventions for people with dementia and depression is limited. One potential solution is guided low-intensity behavioral activation. Following the new Medical Research Council Framework, considering factors such as potential barriers and facilitators to implementation is recommended during the development of new interventions. Aims of this study were to: (1) develop an understanding of existing healthcare and community support in the Swedish context for people with dementia and their informal caregivers; and (2) identify barriers and facilitators to intervention uptake informed by Normalization Process Theory.

METHODS

Semi-structured interviews and focus groups were held with healthcare (n = 18) and community (n = 7) stakeholders working with people with dementia and/or informal caregivers. Interview questions were informed by Normalization Process Theory. Data was analysed utilizing a two-step deductive analysis approach using the Normalization Process Theory coding manual, with inductive categories applied to data related to the main mechanisms of the theory, but not captured by its sub-constructs.

RESULTS

Twelve deductive and three inductive categories related to three Normalization Process Theory primary mechanisms (Coherence, Cognitive Participation, and Collective Action) were identified. Identified barriers to intervention uptake included: (1) additional burden for informal caregivers; (2) lack of appropriate workforce to provide guidance; (3) lack of time and financial resources; (4) people with dementia not recognising their diagnosis of dementia and/or a need for support; and (5) stigma. Identified facilitators to intervention uptake included: (1) intervention has potential to fill a large psychological treatment gap in Sweden; (2) objectives and potential benefits understood and agreed by most stakeholders; and (3) some healthcare professionals recognized their potential role in providing intervention guidance.

CONCLUSIONS

Several barriers and facilitators for future implementation, specific to the intervention, individuals and families, as well as professionals, were identified during intervention development. Barriers were mapped into evidence-based implementation strategies, which will be adopted to overcome identified barriers. A feasibility study further examining implementation potential, acceptability and feasibility, alongside clinical, methodological, and procedural uncertainties associated with the intervention will be conducted.

TRIAL REGISTRATION

Not applicable.

Frameworks for cultural adaptation of psychosocial interventions: A systematic review with narrative synthesis

INTRODUCTION

Psychosocial dementia interventions may be less effective when used with populations for whom they were not initially intended. Cultural adaptation of interventions aims to increase effectiveness of interventions by enhancing cultural relevance. Use of theoretical frameworks may promote more systematic cultural adaptation. The aim of this review was to provide a comprehensive synthesis of published cultural adaptation frameworks for psychosocial interventions to understand important elements of cultural adaptation and guide framework selection.

METHOD

Five scientific databases, grey literature and reference lists were searched to January 2023 to identify cultural adaptation frameworks for psychosocial interventions. Papers were included that presented cultural adaptation frameworks for psychosocial interventions. Data were mapped to the framework for reporting adaptations and modifications to evidence-based interventions, then analysed using thematic synthesis.

RESULTS

Twelve cultural adaptation frameworks met inclusion criteria. They were mostly developed in the United States and for adaptation of psychological interventions. The main elements of cultural adaptation for psychosocial interventions were modifying intervention content, changing context (where, by whom an intervention is delivered) and consideration of fidelity to the original intervention. Most frameworks suggested that key intervention components must be retained to ensure fidelity, however guidance was not provided on how to identify or retain these key components. Engagement (ways to reach and involve recipients) and cultural competence of therapists were found to be important elements for cultural adaptation.

CONCLUSIONS

Comprehensive frameworks are available to guide cultural adaptation of psychosocial dementia interventions. More work is required to articulate how to ensure fidelity during adaptation, including how to identify and retain key intervention components.

An investigation of psychoactive polypharmacy and related gender-differences in older adults with dementia: a retrospective cohort study

BACKGROUND

Older adults living with dementia may express challenging responsive behaviours. One management strategy is pharmacologic treatment though these options often have limited benefit, which may lead to multiple treatments being prescribed.

METHODS

The aim of the present study was to describe psychoactive medication polypharmacy and explore factors associated with psychoactive polypharmacy in a cohort of older adults living with dementia in Nova Scotia, Canada, including a gender-stratified analysis. This was a retrospective cohort study of those aged 65 years or older with a recorded diagnosis of dementia between 2005 and 2015. Medication dispensation data was collected from April 1, 2010, or dementia diagnosis (cohort entry) to either death or March 31, 2015 (cohort exit). Psychoactive medication claims were captured. Psychoactive medication polypharmacy was defined as presence of three or more psychoactive prescription medications dispensed to one subject and overlapping for more than 30 days. Psychoactive polypharmacy episodes were described in duration, quantity, and implicated medications. Regression analysis examined factors associated with experience and frequency of psychoactive polypharmacy. All analysis were stratified by gender.

RESULTS

The cohort included 15,819 adults living with dementia (mean age 80.7 years; 70.0% female), with 99.4% (n = 15,728) receiving at least one psychoactive medication over the period of follow-up. Psychoactive polypharmacy was present in 19.3% of the cohort. The gender specific logistic regressions demonstrated that for both men and women a younger age was associated with an increased risk of psychoactive polypharmacy (women: OR 0.97, 95%CI[0.96, 0.98], men: OR 0.96, 95%CI[0.95, 0.97]). Men were less likely to experience psychoactive polypharmacy if their location of residence was urban (OR 0.86, 95%CI[0.74, 0.99]). There was no significant association between location of residence (urban or rural) and psychoactive polypharmacy for women living with dementia. Antidepressants were the most dispensed medication class, while quetiapine was the most dispensed medication.

CONCLUSIONS

This study suggests that of adults living with dementia those of younger ages were more likely to experience psychoactive polypharmacy and that men living with dementia in rural locations may benefit from increased access to non-pharmacological options for dementia management.

Pharmacological treatment of neuropsychiatric symptoms of dementia: a network meta-analysis

BACKGROUND

Pharmacological treatments are very common to be used for alleviating neuropsychiatric symptoms (NPS) in dementia. However, decision on drug selection is still a matter of controversy.

AIMS

To summarise the comparative efficacy and acceptability of currently available monotherapy drug regimens for reducing NPS in dementia.

METHOD

We searched PubMed, MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials between inception and 26 December 2022 without language restrictions; and reference lists scanned from selected studies and systematic reviews. Double-blind randomised controlled trials were identified from electronic databases for reporting NPS outcomes in people with dementia. Primary outcomes were efficacy and acceptability. Confidence in the evidence was assessed using Confidence in Network Meta-Analysis (CINeMA).

RESULTS

We included 59 trials (15,781 participants; mean age, 76.6 years) and 15 different drugs in quantitative syntheses. Risperidone (standardised mean difference [SMD] -0.20, 95% credible interval [CrI] -0.40 to -0.10) and galantamine (-0.20, -0.39 to -0.02) were more effective than placebo in short-term treatment (median duration: 12 weeks). Galantamine (odds ratio [OR] 1.95, 95% CrI 1.38-2.94) and rivastigmine (1.87, 1.24-2.99) were associated with more dropouts than placebo, and some active drugs. Most of the results were rated as low or very low according to CINeMA.

CONCLUSIONS

Despite the scarcity of high-quality evidence, risperidone is probably the best pharmacological option to consider for alleviating NPS in people with dementia in short-term treatment when considering the risk-benefit profile of drugs.

Cognition-oriented treatments and physical exercise on cognitive function in Huntington's disease: a systematic review

Cognitive impairment is prevalent in Huntington's disease (HD), with no treatments currently available. While cognition-oriented treatments and physical exercise have shown efficacy in improving cognition in other populations, they have not been systematically reviewed in HD. This systematic review aims to examine the effects of cognitive and exercise interventions on cognition in HD, along with effects on psychosocial function, functional independence, and neuroimaging outcomes. Seventeen studies (three cognitive, seven exercise, seven combining cognitive and physical exercise) were included. While there was generally low certainty of evidence, interventions that included cognitive training appeared to have larger effect sizes on cognition, while physical exercise (alone or combined with cognitive rehabilitation or stimulation) showed negligible effect sizes. On the other hand, combined interventions had larger effects on psychosocial function. Finally, effects on functional independence appeared negligible following exercise and combined interventions, and effects on neuroimaging outcomes were inconclusive. Larger studies should seek to confirm the benefits of cognitive and physical interventions, and further explore changes in functional independence and neural outcomes.

Is the Human Touch Always Therapeutic? Patient Stimulation and Spreading Depolarization after Acute Neurological Injuries

Touch and other types of patient stimulation are necessary in critical care and generally presumed to be beneficial. Recent pre-clinical studies as well as randomized trials assessing early mobilization have challenged the safety of such routine practices in patients with acute neurological injury such as stroke. We sought to determine whether patient stimulation could result in spreading depolarization (SD), a dramatic pathophysiological event that likely contributes to metabolic stress and ischemic expansion in such patients. Patients undergoing surgical intervention for severe acute neurological injuries (stroke, aneurysm rupture, or trauma) were prospectively consented and enrolled in an observational study monitoring SD with implanted subdural electrodes. Subjects also underwent simultaneous video recordings (from continuous EEG monitoring) to assess for physical touch and other forms of patient stimulation (such as suctioning and positioning). The association of patient stimulation with subsequent SD was assessed. Increased frequency of patient stimulation was associated with increased risk of SD (OR = 4.39 [95%CI = 1.71-11.24]). The overall risk of SD was also increased in the 60 min following patient stimulation compared to times with no stimulation (OR = 1.19 [95%CI = 1.13-1.26]), though not all subjects demonstrated this effect individually. Positioning of the subject was the subtype of stimulation with the strongest overall effect on SD (OR = 4.92 [95%CI = 3.74-6.47]). We conclude that in patients with some acute neurological injuries, touch and other patient stimulation can induce SD (PS-SD), potentially increasing the risk of metabolic and ischemic stress. PS-SD may represent an underlying mechanism for observed increased risk of early mobilization in such patients.

Comparative Risk of Harm Associated with Zopiclone or Trazodone Use in Nursing Home Residents: a Retrospective Cohort Study in Alberta, Canada

Background

There is growing evidence of harm associated with trazodone and nonbenzodiazepine sedative hypnotics (e.g., zopiclone); however, their comparative risk of harm is unknown.

Methods

We conducted a retrospective cohort study with linked health administrative data, which enrolled older (≥66 years old) nursing home residents living in Alberta, Canada, between December 1, 2009, and December 31, 2018; the last follow-up date was June 30, 2019. We compared the rate of injurious falls and major osteoporotic fractures (primary outcome) and all-cause mortality (secondary outcome) within 180 days of first prescription of zopiclone or trazodone with cause-specific hazard models and inverse probability of treatment weights to control for confounding; primary analysis was intention-to-treat and secondary analysis was per-protocol (i.e., residents censored if dispensed the other exposure drug).

Results

Our cohort included 1,403 residents newly dispensed trazodone and 1,599 residents newly dispensed zopiclone. At cohort entry, the mean resident age was 85.7 (standard deviation [SD] 7.4), 61.6% were female, and 81.2% had dementia. New zopiclone use was associated with similar rates of injurious falls and major osteoporotic fractures (intention-to-treat-weighted hazard ratio 1.15, 95% confidence interval [CI] 0.90-1.48; per-protocol-weighted hazard ratio 0.85, 95% CI 0.60-1.21) and all-cause mortality (intention-to-treat-weighted hazard ratio 0.96, 95% CI 0.79-1.16; per-protocol-weighted hazard ratio 0.90, 95% CI 0.66-1.23) compared to trazodone.

Conclusions

Zopiclone was associated with a similar rate of injurious falls, major osteoporotic fractures, and all-cause mortality compared to trazodone-suggesting one medication should not be used in lieu of the other. Appropriate prescribing initiatives should also target zopiclone and trazodone.

Diagnostic and Management Strategies for Common Neurobehavioral and Psychiatric Disturbances Among Patients with Cognitive Impairment and the Dementias

Neurobehavioral and neuropsychiatric symptoms are highly prevalent among individuals diagnosed with cognitive impairment or dementia and impact the quality of life for patients and caregivers alike. Diagnosis and management of these conditions (including primarily depression, anxiety, apathy, psychosis, agitation, and aggression) is crucial to optimal patient care outcomes in clinical practice. The present article provides a practical review of diagnostic approaches and management strategies for behavioral and neuropsychiatric disorders arising in patients with cognitive impairment, up to and including dementia.

Antidepressant medications in dementia: evidence and potential mechanisms of treatment-resistance

Depression in dementia is common, disabling and causes significant distress to patients and carers. Despite widespread use of antidepressants for depression in dementia, there is no evidence of therapeutic efficacy, and their use is potentially harmful in this patient group. Depression in dementia has poor outcomes and effective treatments are urgently needed. Understanding why antidepressants are ineffective in depression in dementia could provide insight into their mechanism of action and aid identification of new therapeutic targets. In this review we discuss why depression in dementia may be a distinct entity, current theories of how antidepressants work and how these mechanisms of action may be affected by disease processes in dementia. We also consider why clinicians continue to prescribe antidepressants in dementia, and novel approaches to understand and identify effective treatments for patients living with depression and dementia.

Cognitive stimulation to improve cognitive functioning in people with dementia

BACKGROUND

Cognitive stimulation (CS) is an intervention for people with dementia offering a range of enjoyable activities providing general stimulation for thinking, concentration and memory, usually in a social setting, such as a small group. CS is distinguished from other approaches such as cognitive training and cognitive rehabilitation by its broad focus and social elements, aiming to improve domains such as quality of life (QoL) and mood as well as cognitive function. Recommended in various guidelines and widely implemented internationally, questions remain regarding different modes of delivery and the clinical significance of any benefits. A systematic review of CS is important to clarify its effectiveness and place practice recommendations on a sound evidence base. This review was last updated in 2012.

OBJECTIVES

To evaluate the evidence for the effectiveness of CS for people with dementia, including any negative effects, on cognition and other relevant outcomes, accounting where possible for differences in its implementation.

SEARCH METHODS

We identified trials from a search of the Cochrane Dementia and Cognitive Improvement Group Specialized Register, last searched on 3 March 2022. We used the search terms: cognitive stimulation, reality orientation, memory therapy, memory groups, memory support, memory stimulation, global stimulation, cognitive psychostimulation. We performed supplementary searches in a number of major healthcare databases and trial registers to ensure the search was up-to-date and comprehensive.

SELECTION CRITERIA

We included all randomised controlled trials (RCTs) of CS for dementia published in peer review journals in the English language incorporating a measure of cognitive change.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane. As CS is a psychosocial intervention, we did not expect those receiving or delivering CS to be blinded to the nature of the intervention. Where necessary, we contacted study authors requesting data not provided in the papers. Where appropriate, we undertook subgroup analysis by modality (individual versus group), number of sessions and frequency, setting (community versus care home), type of control condition and dementia severity. We used GRADE methods to assess the overall quality of evidence for each outcome.

MAIN RESULTS

We included 37 RCTs (with 2766 participants), 26 published since the previous update. Most evaluated CS groups; eight examined individual CS. Participants' median age was 79.7 years. Sixteen studies included participants resident in care homes or hospitals. Study quality showed indications of improvement since the previous review, with few areas of high risk of bias. Assessors were clearly blinded to treatment allocation in most studies (81%) and most studies (81%) reported use of a treatment manual by those delivering the intervention. However, in a substantial number of studies (59%), we could not find details on all aspects of the randomisation procedures, leading us to rate the risk of selection bias as unclear. We entered data in the meta-analyses from 36 studies (2704 participants; CS: 1432, controls: 1272). The primary analysis was on changes evident immediately following the treatment period (median length 10 weeks; range 4 to 52 weeks). Only eight studies provided data allowing evaluation of whether effects were subsequently maintained (four at 6- to 12-week follow-up; four at 8- to 12-month follow-up). No negative effects were reported. Overall, we found moderate-quality evidence for a small benefit in cognition associated with CS (standardised mean difference (SMD) 0.40, 95% CI 0.25 to 0.55). In the 25 studies, with 1893 participants, reporting the widely used MMSE (Mini-Mental State Examination) test for cognitive function in dementia, there was moderate-quality evidence of a clinically important difference of 1.99 points between CS and controls (95% CI: 1.24, 2.74). In secondary analyses, with smaller total sample sizes, again examining the difference between CS and controls on changes immediately following the intervention period, we found moderate-quality evidence of a slight improvement in self-reported QoL (18 studies, 1584 participants; SMD: 0.25 [95% CI: 0.07, 0.42]) as well as in QoL ratings made by proxies (staff or caregivers). We found high-quality evidence for clinically relevant improvements in staff/interviewer ratings of communication and social interaction (5 studies, 702 participants; SMD: 0.53 [95% CI: 0.36, 0.70]) and for slight benefits in instrumental Activities of Daily Living, self-reported depressed mood, staff/interviewer-rated anxiety and general behaviour rating scales. We found moderate-quality evidence for slight improvements in behaviour that challenges and in basic Activities of Daily Living and low-quality evidence for a slight improvement in staff/interviewer-rated depressed mood. A few studies reported a range of outcomes for family caregivers. We found moderate-quality evidence that overall CS made little or no difference to caregivers' mood or anxiety. We found a high level of inconsistency between studies in relation to both cognitive outcomes and QoL. In exploratory subgroup analyses, we did not identify an effect of modality (group versus individual) or, for group studies, of setting (community versus care home), total number of group sessions or type of control condition (treatment-as-usual versus active controls). However, we did find improvements in cognition were larger where group sessions were more frequent (twice weekly or more versus once weekly) and where average severity of dementia among participants at the start of the intervention was 'mild' rather than 'moderate'. Imbalance in numbers of studies and participants between subgroups and residual inconsistency requires these exploratory findings to be interpreted cautiously.

AUTHORS' CONCLUSIONS

In this updated review, now with a much more extensive evidence base, we have again identified small, short-term cognitive benefits for people with mild to moderate dementia participating in CS programmes. From a smaller number of studies, we have also found clinically relevant improvements in communication and social interaction and slight benefits in a range of outcomes including QoL, mood and behaviour that challenges. There are relatively few studies of individual CS, and further research is needed to delineate the effectiveness of different delivery methods (including digital and remote, individual and group) and of multi-component programmes. We have identified that the frequency of group sessions and level of dementia severity may influence the outcomes of CS, and these aspects should be studied further. There remains an evidence gap in relation to the potential benefits of longer-term CS programmes and their clinical significance.

The Efficacy of Reminiscence Therapy in Cancer-Related Symptom Management: A Systematic Review and Meta-Analysis

BACKGROUND

At present, simple reminiscence has been widely used in the field of neurocognitive disorders, life review/life review therapy has been widely used in the field of cancer, and both simple reminiscence and life review/life review therapy are suitable for psychological disorders such as depression and anxiety. However, the efficacy of reminiscence in treating cancer-related symptom has not been fully assessed.

OBJECTIVES

To evaluate the effect of reminiscence therapy (RT) on relieving cancer-related symptoms such as anxiety and depression in cancer survivals.

METHODS

China National Knowledge Infrastructure (CNKI), VIP database, Wanfang Data Knowledge Service Platform, China Biomedical Database, PubMed, Cochrane Library, Embase, EBSCO, Scopus, and Ovid databases were searched. To collect clinical randomized controlled trials (RCT) on RT and cancer-related studies published from the establishment of the database to October 05, 2021. Two researchers independently evaluated the articles that met the inclusion criteria, meta-analysis was performed using RevMan5.4 software.

RESULTS

A total of 20 RCTs published in 2010 to 2021 were included, with a total of 1853 cancer patients. Meta-analysis results showed that the anxiety scale (HADS-A and HAMA and SAS) and depression scale (HADS-D and HAMD and SDS) scores of the RT group were significantly lower than those of the control group (HADS-A: P = .0002; HAMA: P < .00001; SAS: P = .0010; HADS-D: P = .01; HAMD: P < .00001; SDS: P = .0001). Meta-analysis results showed that RT can improve overall quality of life of cancer patients of RT group to a certain extent hope (P < .00001). Meta-analysis results showed that the scores on the hope and dignity were significantly increased, and the difference were statistically significant (P < .001).

CONCLUSION

This review indicates that RT has significant efficacy on cancer-related symptoms such as anxiety and depression. RT for cancer survivals can effectively improve quality of life, self-hope, and self-esteem. The findings of this meta-analysis can provide direction for future symptom management research.

Comparative effectiveness of exercise, antidepressants and their combination in treating non-severe depression: a systematic review and network meta-analysis of randomised controlled trials

OBJECTIVE

To assess the comparative effectiveness of exercise, antidepressants and their combination for alleviating depressive symptoms in adults with non-severe depression.

DESIGN

Systematic review and network meta-analysis.

DATA SOURCES

Embase, MEDLINE, PsycINFO, Cochrane Library, Web of Science, Scopus and SportDiscus.

ELIGIBILITY CRITERIA

Randomised controlled trials (1990-present) that examined the effectiveness of an exercise, antidepressant or combination intervention against either treatment alone or a control/placebo condition in adults with non-severe depression.

STUDY SELECTION AND ANALYSIS

Risk of bias, indirectness and the overall confidence in the network were assessed by two independent investigators. A frequentist network meta-analysis was performed to examine postintervention differences in depressive symptom severity between groups. Intervention drop-out was assessed as a measure of treatment acceptability.

RESULTS

Twenty-one randomised controlled trials (n=2551) with 25 comparisons were included in the network. There were no differences in treatment effectiveness among the three main interventions (exercise vs antidepressants: standardised mean differences, SMD, -0.12; 95% CI -0.33 to 0.10, combination versus exercise: SMD, 0.00; 95% CI -0.33 to 0.33, combination vs antidepressants: SMD, -0.12; 95% CI -0.40 to 0.16), although all treatments were more beneficial than controls. Exercise interventions had higher drop-out rates than antidepressant interventions (risk ratio 1.31; 95% CI 1.09 to 1.57). Heterogeneity in the network was moderate (τ2=0.03; I2=46%).

CONCLUSIONS

The results suggest no difference between exercise and pharmacological interventions in reducing depressive symptoms in adults with non-severe depression. These findings support the adoption of exercise as an alternative or adjuvant treatment for non-severe depression in adults.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD4202122656.

Effectiveness of reminiscence therapy interventions for older people: Evidence mapping and qualitative evaluation

WHAT IS KNOWN ON THE SUBJECT?: Reminiscence therapy is a common psychosocial intervention in mental health nursing. Numerous secondary studies have explored the effects of reminiscence therapy interventions in older adults, and while the effects are significant, conflicting results remain. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: To date, research on reminiscence therapy has examined different disorders in isolation from one another. By illustrating the evidence gaps between studies, this paper highlights the need for a new evidence-based summary overview of reminiscence therapy research. The results suggest that reminiscence therapy can be beneficial to the improvement of mental health and quality of life for older people. However, we found that the secondary studies were not of high quality and that further high-quality literature supporting the evidence is still needed. WHAT ARE THE IMPLICATION FOR PRACTICE?: Reminiscence therapy may be considered a useful non-pharmacological intervention for older people with mental and psychological problems. However, there is a lack of normative guidelines for reminiscence therapy in terms of intervention time, frequency, and form. The development of a global standard protocol for the application of reminiscence therapy may be necessary for future randomized controlled trials (RCTs).

ABSTRACT

INTRODUCTION: Reminiscence therapy is an alternative to pharmaceutical intervention provided during long-term care, especially for older people with mental and psychological problems. However, the effects of reminiscence therapy remain inconclusive.

AIM

The present study aimed to systematically identify, synthesize and describe the research evidence and quality of systematic reviews (SRs) related to reminiscence interventions for older people through an evidence-mapping approach.

METHODS

Commonly used English and Chinese databases, including PubMed, EMBASE, The Cochrane Library, Web of Science, CNKI, WANFANG, VIP and SinoMed, were searched from inception till 31 March 2022. The study type was restricted to SRs with or without meta-analysis. The methodological quality of the included SRs was assessed by A Measurement Tool to Assess Systematic Reviews (AMSTAR-2). The Microsoft Excel 2019 tool was used for data extraction and coding, and bubble charts were used to synthesize information on the study population, intervention category, original study sample size and classification of findings.

RESULTS

A total of 28 SRs were enrolled, including 514 original studies, 91.4% of which were randomized controlled trials. The main participants of the study were depressed older people (7 publications), older people with dementia (10 publications) and ordinary older people (8 publications). The findings of 26 (92.8%) publications were categorized as either "beneficial" or "potentially beneficial." The primary outcome indicators of the effectiveness of the reminiscence intervention for older people are mental and psychological problems (especially depressive symptoms and cognitive functioning), quality of life and categories of positive psychology (e.g., life satisfaction, happiness and self-esteem). The main factors influencing the intervention effect were the intervention period, residential setting, intervention format (group/individual) and intervention intensity. The intervention settings/contexts were mainly community and long-term care facilities. However, the methodological quality of 27 (96.4%) of the SRs was scored as either "Low" or "Critically Low."

DISCUSSION

Reminiscence therapy has been used to study the mental health and quality of life of older people in various conditions, with significant results. However, due to the limited evidence included in the studies and the low methodological quality, there is still a need to focus on the issue of effectiveness and evidence gaps for different interventions in the field of recall in the future, in addition to efforts to improve the methodological quality and standardize the reporting process for the evaluation of reminiscence intervention systems.

IMPLICATIONS FOR PRACTICE

Reminiscence therapy may be considered a useful non-pharmacological intervention for older people with mental and psychological problems. A standard protocol for reminiscence therapy may be necessary for future studies.

Effectiveness of primary care psychological therapy services for the treatment of depression and anxiety in people living with dementia: Evidence from national healthcare records in England

Background

Depression and anxiety are common and deleterious in people living with dementia (PLWD). It is currently unknown whether routinely provided psychological therapy can help reduce these symptoms in PLWD. This study aimed to investigate improvements in depression and anxiety symptoms over the course of therapy offered in primary care psychological therapy services in PLWD and to compare outcomes to people without dementia.

Methods

National data from Improving Access to Psychological Therapies services (IAPT) across England linked with Hospital Episode Statistics data, the Mental Health Services Dataset, and HES-ONS mortality data were used to identify 1,549 PLWD who completed a course of psychological treatment in IAPT between 2012-2019 and a propensity score matched control group without identified dementia. Outcome measures included pre-post intervention changes in depression (PHQ-9) and anxiety (GAD-7) symptoms and therapy outcomes (reliable improvement, recovery, deterioration).

Findings

Symptoms of depression (t(1548)=31·05, p<·001) and anxiety (t(1548)=30·31, p<·001) improved in PLWD over the course of psychological therapy with large effect sizes (depression: d=-0·83; anxiety: d=-0·80). However, PLWD were less likely to reliably improve (OR=·75, 95%CI[·63,·88], p<·001) or recover (OR=·75, 95%CI[·64,·88], p=·001), and more likely to deteriorate (OR=1·35, 95%CI[1·03,1·78], p=·029) than a matched control sample without dementia.

Interpretation

Psychological therapy may be beneficial for PLWD with depression or anxiety, but it is currently not as effective as for people without dementia. More research is needed to improve access to psychological therapies and to understand this discrepancy and how therapies can be adapted to further improve outcomes.

Funding

This work was supported by the Alzheimer's Society.

The Course of Depressive Symptoms Over 36 Months in 696 Newly Admitted Nursing Home Residents

OBJECTIVES

To investigate the course of depressive symptoms in newly admitted nursing home (NH) residents and how resident characteristics were associated with the symptoms. To identify groups of residents following the same symptom trajectory.

DESIGN

An observational, multicenter, longitudinal study over 36 months with 7 biannual assessments.

SETTING AND PARTICIPANTS

Representing 47 Norwegian NHs, 696 residents were included at admission to a NH.

METHODS

Depressive symptoms were assessed with the Cornell Scale for Depression in Dementia (CSDD). We selected severity of dementia, functional impairment, physical health, pain, use of antidepressants, age, and sex as covariates. Time trend in CSDD score was assessed by a linear mixed model adjusting for covariates. Next, a growth mixture model was estimated to investigate whether there were groups of residents following distinct trajectories in CSDD scores. We estimated a nominal regression model to assess whether the covariates at admission were associated to group membership.

RESULTS

There was a nonlinear trend in CSDD score. More severe dementia, a lower level of functioning, poorer physical health, more pain, use of antidepressants, and younger age at admission were associated with higher CSDD scores. Growth mixture model identified 4 groups: (1) persistent mild symptoms (32.6%), (2) persistent moderate symptoms (50.8%), (3) increasing symptoms (5.1%), and (4) severe but decreasing symptoms (11.6%). A lower level of functioning, poorer physical health, more pain, use of antidepressants, and younger age at admission were associated with higher odds for belonging to the severe but decreasing symptoms group compared with the persistent mild symptoms group.

CONCLUSIONS AND IMPLICATIONS

Most NH residents were in trajectory groups with persistent mild or moderate depressive symptoms. Residents with more severe dementia, lower levels of functioning, poor physical health, severe pain, younger age at admittance, and who are using antidepressants should be monitored closely and systematically with respect to depression. Taking actions toward a more personalized treatment for depression in NHs is a priority and should be investigated in future studies.

Prevalence and Predictors of Symptoms in Persons with Advanced Dementia Living in the Community

Background: Behavioral, psychological, and physical symptoms are prevalent in advanced dementia, as well as major contributors to poor quality of life, health care costs, caregiver burden, and nursing home placement. Objectives: To determine the frequency and severity of symptoms in persons with advanced dementia living in the community, as well as the association between symptoms and satisfaction with care, and the identification of factors associated with symptom burden. Design: Baseline data from a clinical trial testing the effectiveness of collaborative care home-based management for patients with advanced dementia. Setting/Subjects: Two hundred and one patient-caregiver dyads from an urban area in the United States, who were still residing in the community. Measurements: Caregivers completed the Symptom Management in End-of-Life Dementia (SM-EOLD) and Satisfaction with Care in End-of-Life Dementia (SWC-EOLD) scales. Results: Patients' mean age was 83.1; 67.7% were women, and most were either White (50.2%) or African American (43.8%). Most (88.1%) had severe dementia (Functional Assessment Staging Tool [FAST] stage 6 or 7). SM-EOLD mean score was 29.3 (on 0-45 scale) and SWC-EOLD score was 32.6 (on 10-40 scale). Pain, agitation, anxiety, and resistiveness to care were present at least weekly in ≥40% of patients. Multivariable linear regression modeling showed that higher neuropsychiatric symptom severity (assessed by the Neuropsychiatric Inventory), increased caregiver strain, and higher medical comorbidity were all independently associated with increased symptom burden. Satisfaction with care was high and had only a modest correlation (r = 0.20) with symptom burden. Conclusions: Community-dwelling patients with advanced dementia and their caregivers may benefit from home-based palliative care interventions to identify and manage burdensome symptoms.

Palliative care for patients with advanced dementia

ABSTRACT

Dementia is currently the seventh leading cause of death and one of the major causes of disability and dependency among older adults globally. Its final stages are complicated by a multitude of problems that can cause immense suffering. This article explores the interconnection between advanced dementia and palliative care and the role of nurses in providing end-of-life care for these patients.