Adjunctive Therapy to Manage Neuropsychiatric Symptoms in Moderate and Severe Dementia: Randomized Clinical Trial Using an Outpatient Version of Tailored Activity Program

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.

Integrative Stress Reduction Program for Family Caregivers of Persons With Advanced Dementia: A Randomized-Controlled Trial

BACKGROUND

Older adults with advanced dementia require significant care, leading to high stress levels in caregivers.

OBJECTIVES

The current study aimed to evaluate the effects of an Integrative Stress Reduction Program on Thai caregiver's outcomes of stress, sleep quality, and caregiver-assessed neuropsychiatric symptoms of persons with dementia.

METHODS

A single-blind randomized-controlled trial was conducted. A sample of family caregivers of people with dementia was recruited from memory clinics at outpatient community health centers in Thailand and randomly assigned to the experimental and control groups. Participants in the experimental group were enrolled in 5 intervention sessions over 4 weeks, while the control group received usual care. Outcome variables were collected at baseline, 4 weeks postintervention, and 8 weeks of follow-up.

RESULTS

Compared with the control group, caregivers in the experimental group (n = 27) had significantly decreased stress (p < .01) and better sleep quality (p < .01), and caregivers reported that their family members with dementia (n = 27) had decreased neuropsychiatric symptoms (p < .01) after the intervention (week 4) and at the 8-week follow-up.

CONCLUSIONS

The Integrative Stress Reduction Program improved outcomes for caregivers and decreased neuropsychiatric symptoms in people with dementia.

Occupational Therapy Interventions for Dementia Caregivers: Scoping Review

BACKGROUND AND PURPOSE

caregivers of people with dementia (PwD) often experience a significant caregiver burden. Occupational Therapy (OT) is a helpful discipline for improving quality of life and other health factors for these caregivers. We conducted a Scoping Review to describe OT interventions for caregivers of PwD.

METHODS

two authors searched PubMed, Scopus, EMBASE and Web of Science databases and OT journals indexed in the Journal Citation Reports. Terms included in the search strategy were: dementia, Alzheimer, Parkinson, caregivers and OT. We included articles with experimental design in which an OT intervention in caregivers of PwD was carried out, written in Spanish or English and with the full text available.

RESULTS

a total of 2121 articles were obtained, 31 of which were included; 22 of them described home-based OT interventions: Tailored Activity Program (TAP) (n = 5), Environmental Skill-Building Program (ESP) (n = 4) and Advancing Caregiver Training (ACT) (n = 3) and other household interventions (n = 10); the remaining studies described OT interventions in other settings (n = 9).

CONCLUSIONS

OT interventions for caregivers of PwD were mainly carried out at home. The most commonly used interventions were TAP focused on caregivers of people with Alzheimer's disease, aimed at lessening the burden, depression and stress experienced by caregivers.