Animal-Assisted Therapy Improves Communication and Mobility among Institutionalized People with Cognitive Impairment

The effect of animal assisted rehabilitation practices on symptoms of Alzheimer's patients: systematic review and meta-analysis

OBJECTIVE

To determine the impact of animal-assisted rehabilitation interventions on symptom management in Alzheimer's disease patients.

METHODS

This study is a systematic review and meta-analysis based on PRISMA 2022 guidelines, which adhered to the Cochrane 2021 guidelines. Databases including PubMed, Web of Science, and Cochrane Library were searched between February 1, 2023, and November 28, 2023. Two authors independently assessed the risk of bias using the Cochrane Collaboration tool. Review Manager 5.4.1 software was utilized for the meta-analysis.

RESULTS

Six randomized controlled trials were included. This meta-analysis demonstrated that animal-assisted rehabilitation interventions significantly impacted physical outcomes, such as improving physical competence and independence in basic daily living activities, as well as psychological outcomes, including reducing depression and enhancing mini-mental state examination scores in Alzheimer's patients.

CONCLUSION

This meta-analysis revealed that animal-assisted rehabilitation interventions effectively reduce cognitive decline and depression symptoms in Alzheimer's patients.

Witnessing Self-Affirming Moments in Persons with Dementia While Interacting with Therapy Dogs: A Case Report

Individuals, families, and communities are impacted by Alzheimer's disease and other dementias worldwide. In Canada and elsewhere, family members commonly see loved ones living with dementia experience difficult moments, including anxiety, stress, and fear. Struggling health care systems strive to apply the latest evidence-based interventions. In this case report, we explore how individuals who care for people with dementia can help redirect difficult personal and interpersonal moments towards hopeful moments in the presence of therapy dogs. The cases of four individuals diagnosed with dementia and interacting with therapy dog intervention in one of three environments-at a family home, in a hospital awaiting placement to a long-term care facility, and in a psychiatric centre-are reviewed from the perspectives of two attending therapy dog handlers. In addition to being researchers in the therapy dog field and authors on this case report, both handlers were guided in a 110 min focused conversational method by a third author, from which self-affirmation theory surfaced as a guiding framework for explaining their observations and experiences. Therapy dog visiting appears to facilitate positive social interactions that can help redirect difficult moments to moments defined by self-affirmation or experiencing a positive sense of self. This is an under-recognized association in the dementia literature. Self-affirmation is demonstrated through four themes during therapy dog visits: (a) physical movement, (b) psychological shift, (c) a transition in the experience of time, and (d) connective interactions. Therapy dogs are identified here as a promising self-affirming psychosocial intervention for individuals with dementia and their caregivers worthy of further research and practice attention.

Animal-assisted services for adults with acquired neurogenic communication disorders: A scoping review

BACKGROUND

There is increasing interest in the incorporation of animal-assisted services (AAS) in therapy for adults with acquired neurogenic communication disorders. AAS have the potential to enhance speech and language therapy engagement and outcomes. However, a greater understanding of the nature and potential benefits of these interventions is needed.

AIMS

To describe the existing evidence for the incorporation of AAS in therapy with adults with acquired neurogenic communication disorders and to identify areas for future research.

METHODS & PROCEDURES

A scoping review was conducted and reported in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist extension for scoping reviews (PRISMA-ScR). Seven databases (PubMed, Embase, CINAHL, PsycINFO, Cochrane, Scopus, Web of Science) and grey literature (Google) were searched. Two reviewers independently screened titles, abstracts and full texts against eligibility criteria using Covidence software. The Template for Intervention Description and Replication (TIDieR) checklist guided extraction of intervention data.

MAIN CONTRIBUTIONS

A total of 17 studies with adults with aphasia, apraxia of speech and cognitive-communication disorders were included. While terminology varied, most interventions met the definition of animal-assisted therapy or animal-assisted activity and used therapy dogs. Across studies, a range of outcomes were targeted, and positive benefits were reported for participant mood, emotions, motivation and satisfaction. There were mixed, but mostly positive, benefits on social behaviour, communication and participation.

CONCLUSIONS & IMPLICATIONS

AAS has been incorporated in therapy for adults with acquired neurogenic communication disorders, predominately with people with dementia. Across studies, communication impairments and AAS interventions were insufficiently or inconsistently described. Improved reporting would assist understanding of the potential benefits of AAS as an adjunct therapy. A quality appraisal of existing studies, and meta-analysis of findings, is needed to draw conclusions about the effectiveness of AAS as a complementary therapy for people with acquired neurogenic communication disorders.

WHAT THIS PAPER ADDS

What is already known on this subject There is increasing interest and research in AAS as an adjunct to traditional speech and language therapy. Several clinical populations have been shown to benefit from the incorporation of AAS as a complementary therapy approach, including adults with acquired neurogenic communication disorders. To date there has not been a comprehensive review of literature in the area. What this paper adds to the existing knowledge This review aimed to describe what is known about AAS as an adjunct intervention for adults with acquired neurogenic communication disorders. A total of 17 studies were identified, the majority conducted with people living with dementia. Overall, consistent positive benefits of AAS were reported on participant mood, positive emotions, motivation, and satisfaction. There were mixed, but mostly positive, benefits of AAS on social behaviour, including both verbal and non-verbal communication outcomes, and participation. What are the practical and clinical implications of this work? These results suggest a potential therapeutic benefit for the inclusion of AAS into traditional modalities used by speech-language therapists with people with acquired neurogenic communication disorders. However, clinicians should view these findings with caution. Studies were often insufficiently or inconsistently reported, and a quality appraisal and meta-analysis of existing studies would be needed to draw clear conclusions on the effectiveness of AAS as a complementary approach for people with acquired neurogenic communication disorders.

Job Analysis and Curriculum Design of South Korean Animal-Assisted Therapy Specialists Using DACUM

This study analyzed the jobs of animal-assisted therapy specialists using the Development of a Curriculum (DACUM) technique, a job analysis method for the duties and tasks performed in a specific job. It derived nine duties and 54 tasks through a verification process. In addition, by analyzing the knowledge, skills, and attitudes according to the task, the duties of animal-assisted therapy specialists were derived with 37 knowledge points (K), 32 skills (S), and 46 attitudes (A). The curriculum was designed based on the results derived from the job analysis. The final derived subjects were "understanding the counselee", "clinical practice", "therapy-assisted animal management", "case conceptualization", "psychological test and evaluation", "program development", "understanding and practice of counseling psychology", "animal-assisted intervention introduction", "evaluation analysis and report", "case study and practice", "case guidance and management", "training and behavior", and "animal welfare". These results can improve the professionalism of animal-assisted therapy specialists and the overall quality of the therapy site.

Challenges to conducting research on oral health with older adults living in long-term care facilities

BACKGROUND

The challenges to conducting oral health studies involving older people in long-term care facilities (LTCFs) must be debated.

OBJECTIVE

This study aimed to investigate researchers' perceptions and experiences while conducting an epidemiological survey on oral health among older individuals residing in LTCFs.

METHODS

A qualitative study was conducted involving six researchers who utilized field diaries to record their impressions during data collection through interviews (older individuals (or their proxies), caregivers, and LTCF coordinators) and oral examinations of the older people participants. Additionally, researchers responded to open-ended questions about their experiences. The collected material was subjected to content analysis by two researchers.

RESULTS

The themes that emerged from the analysis were institutional context, aspects affecting the operationalization of the study, and data collection oriented by the clinical-functional profile of the older people. According to the researchers' perceptions, LTCF coordinators demonstrated concern for the study's benefits for older adults and the preservation of institutional routines during the research process. Caregivers emerged as vital sources of information, guiding researchers in navigating the challenges posed by the physical and mental complexities of the older people participants, necessitating empathy, sensitivity, and attentive listening from the researchers. The organization of materials and a streamlined data collection process proved essential for optimizing time efficiency and reducing stress for participants and researchers.

CONCLUSION

The researchers recognized the important role played by LTCF coordinators and formal caregivers, underscoring the significance of empathetic methodologies and streamlined data collection processes in mitigating the challenges inherent to research conducted within LTCFs.

The role of animal-assisted programs in physical health improvement of children and adolescents with special education needs - a systematic review

Programs involving animals in therapeutic programs are becoming increasingly prevalent. These programs can vary greatly in their approach, scope, and objectives, and they can significantly impact the development of healthy children and those with various disorders. In this systematic review, we sought to investigate the psychological ramifications of animal-assisted activities (AAA), therapies (AAT), and interventions (AAI). We searched for relevant studies using the EBSCO Discovery Service search engine across 85 databases, utilising appropriate keywords. Our search generated 262 results, of which 21 were selected for inclusion after title and abstract screening, as well as full-text analysis. Our findings indicate that dogs and horses are animal-assisted programs' most commonly used animals. Additionally, autism, cerebral palsy, and ADHD were found to be overrepresented in these programs. Furthermore, the length of sessions and overall program duration exhibited considerable variation, regardless of patient age or disease type. The principal measures centred on the physiological variables related to the nervous system and motorium-related indicators. The studies were generally of exceptional methodological soundness. Frequently, the studies narrowed their scope to a single segment or just the child or adolescent, but the outcomes lacked contextual interpretation. Expanding the range of studies by comparing psychological and physiological indicators and conducting follow-up analysis with a longitudinal design would be beneficial.

The effectiveness of a therapeutic robot, 'Paro', on behavioural and psychological symptoms, medication use, total sleep time and sociability in older adults with dementia: A systematic review and meta-analysis

OBJECTIVE

To evaluate the effectiveness of a therapeutic robot, 'Paro', on anxiety, agitation, depression, apathy, medication use, total sleep time, and sociability among older adults with dementia.

DESIGN

Systematic review and meta-analysis with narrative synthesis.

SETTING AND PARTICIPANTS

Older adults aged 60 years and above with any form of dementia in the community, nursing homes, or care facilities.

METHODS

A three-step search strategy was conducted by two independent reviewers. Nine databases were searched (January 2003 to November 2022). Randomised controlled, crossover, and cluster trials on Paro for older adults with dementia published in English were included. All relevant trials were screened and assessed for risk of bias. Data were extracted using the Cochrane data collection form. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to assess the quality of evidence.

RESULTS

In total, 12 articles involving 1461 participants were included. Results of the meta-analysis showed that Paro had a moderate effect on medication use (SMD: -0.63) and small effect on anxiety (SMD: -0.17), agitation (SMD: -0.27) and depression (SMD: -0.40). However, Paro exhibited negligible effect on total sleep time (SMD: -0.12). The overall quality of evidence for all outcomes were graded as low due to methodological limitations, small sample size, and wide confidence intervals. Narrative synthesis suggested that Paro reduced apathy and increase sociability.

CONCLUSION AND IMPLICATIONS

Paro could be a beneficial non-pharmacological approach to improve behavioural and psychological symptoms of dementia, reducing medication use, and increasing sociability for older adults with dementia. However, the results should be interpreted with caution as limited studies were available. Additionally, there were a variety of approaches across the studies (i.e. group and individual interventions, facilitated and non-facilitated) which made it difficult to determine which interventional approach is optimal to produce beneficial effects of Paro. Hence, more rigorous studies with a larger sample size are needed to fully understand the mechanism and effectiveness of Paro in older adults with dementia. The protocol was registered on PROSPERO (CRD42022296504).

Animal-assisted and robotic animal-assisted interventions within dementia care: A systematic review

BACKGROUND

Animal-assisted interventions and robotic animal interventions are becoming increasingly popular to support the care of people with dementia and may have the potential to improve a range of psychosocial outcomes. This review aims to identify, describe, and compare animal-assisted and robotic animal interventions delivered to people with dementia, their characteristics, effectiveness, and the proposed mechanisms underlying any potential impact.

METHODS

A systematic literature search was conducted in MEDLINE, AMED, EMBASE, PsycINFO, OVID Nursing, PubMed, CINAHL and Web of Science. Random-effects meta-analyses of randomised controlled trials (RCTs) were conducted to summarise studies that evaluated common outcomes (agitation, depression, quality of life). A narrative approach was used to synthesise other findings.

RESULTS

Fifty-one studies were included: 18 RCTs; 12 non-randomised trials, 13 cohort studies, 7 qualitative studies and one mixed-methods study. Meta-analyses were conducted for a small number of RCTs, with effectiveness of animal-assisted interventions demonstrated for agitation. Narrative findings suggested animal-assisted and robotic animal interventions may be promising in improving depression, agitation, and quality of life. Three potential mechanisms of action were identified for both animal-assisted and robotic animal interventions, namely enhancing social connections, providing engaging and meaningful activities, and the affect-generating aspect of the human-animal bond. A fourth mechanism was identified for animal-assisted interventions only: promoting physical activity. Robotic animals appear to have a place in complex human-animal relationships, but a greater understanding of robotic animal interventions is required to harness the benefits that may be derived from their use.

CONCLUSION

Delivering these interventions appear promising in improving psychosocial outcomes for people with dementia. As most included studies had methodological limitations, these findings are preliminary, but contribute to the body of evidence providing an understanding in terms of intervention characteristics and mechanisms of action. When developing intervention guidance, attention should be given to potential mechanisms and fundamental characteristics such as session content, delivery format and facilitator role.

What moral work can Nussbaum's account of human dignity do in the context of dementia care?

Appeals to the dignity of people with dementia are widespread in the current literature on dementia care. One influential account of dignity in the wider philosophical and bioethical literature that has remained underexplored in the context of dementia care is that of Martha Nussbaum. This paper critically examines Nussbaum's account of dignity and aims to determine what moral guidance this account can offer for the provision of care to people with dementia. To that end, first, I identify four possible objections to appeals to dignity in dementia care. These objections are (1) redundancy of the dignity talk, (2) exclusionary implications, (3) reliance on (suspect forms of) speciesism and (4) unclear practical implications. Then, I discuss whether, and to what extent, Nussbaum's account of dignity can overcome these objections. I argue that Nussbaum's account, in its original form, struggles to overcome the problem of exclusionary implications and consequently the problem of unclear practical implications. I argue for a modified version of Nussbaum's account of dignity. I demonstrate that this modified version can better overcome all of the four objections, and it provides relatively clearer moral guidance for the provision of care to people with dementia. The modified version of Nussbaum's account is predicated on a novel dementia-specific model of flourishing, which draws on Kitwood and Bredin's empirically informed list of indicators of well-being for people with dementia.

Daily Mobility and Social Interactions Among Community-Dwelling Older Adults With Pet Dogs: A Scoping Review

Dogs are part of many people's lives and are involved in interventions to improve the well-being of older adults in institutional settings. However, the literature on the impact of pet dogs on community-dwelling older adults is still relatively limited. This study mapped the impact of having a companion dog on the daily mobility and social interactions of community-dwelling older adults using a scoping review. Electronic databases were searched, and studies written in English, Portuguese, and Spanish that were published in a peer-reviewed journal were identified. After a careful review, 26 eligible studies were identified, and relevant findings were extracted. The main findings indicated that having a dog may promote or hinder daily mobility and social interactions and that having a dog is about routines and sharing affection. More research is needed to clarify what makes having a companion dog key to promoting active and healthy aging.

Specific and Non-specific Factors of Animal-Assisted Interventions Considered in Research: A Systematic Review

Research on animal-assisted interventions (AAIs) has increased massively in the last few years. But it is still not clear how AAIs work and how important the animal is in such interventions. The aim of this systematic review was to compile the existing state of knowledge about the working mechanisms of AAIs. We searched 12 major electronic databases for previous AAI studies with active control groups. Of 2001 records identified, we included 172 studies in the systematic review. We extracted previously published hypotheses about working mechanisms and factors that have been implicitly considered specific or non-specific in AAI research by categorizing control conditions using content analysis. We analyzed the categories using descriptive statistics. We found that 84% of the included studies mentioned a hypothesis of working mechanisms, but 16% did not define specific hypotheses. By analyzing their control conditions, we found that in most controlled studies, the animal or the interaction with the animal was implicitly considered as a specific factor for the effects of the AAI. Non-specific factors such as therapeutic aspects, social interactions, or novelty have also been controlled for. We conclude that AAI research still cannot answer the question of how and why AAIs work. To address this important research gap, we suggest using component studies with innovative control conditions and results from placebo research to address both the specific and non-specific, contextual factors of AAIs to disentangle its mechanisms.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=158103, identifier: CRD42020158103.

Working like a Dog: Exploring the Role of a Therapy Dog in Clinical Exercise Physiology Practice

Therapy animals in clinical settings are purported to reduce patients’ anxiety, decrease agitated behaviour, serve as social mediators, enhance the social atmosphere, and increase patients’ openness towards practitioners. A therapy dog worked alongside her exercise physiologist handler for approximately 1 day/week in a university clinic. The canine and handler functioned as a team, while the handler simultaneously undertook supervision of students. The clinic was open 24 h/week, and no other therapeutic animal was present for any part of the week. We explored, via surveys and interviews, human responses to the dog. The survey comprised 15 statement items regarding the canine’s role, behaviour, and acceptability in the clinic, ranked from strongly disagree (−2) to strongly agree (2), followed by an open item inviting participants to follow up interviews. Eleven (11) clinical clients and seven (7) students completed the survey. One client had not encountered the canine; these data were excluded. Four (4) participants from the client sample provided subsequent telephone interviews. All participants identified the canine as well-behaved; no participants considered that she detracted from their exercise sessions. Most participants were equivocal to statements regarding social lubrication and openness to practitioners; only three clients and two students identified that they felt more willing to share health information; three students identified that they felt they could confide more in the canine than in the practitioner. Interviewees’ reports were similarly favourable, reinforcing the information obtained from the surveys. Interview transcripts were subject to thematic analysis, which focussed around four key themes: (1) the canine’s good behaviour, (2) clients giving permission, and the canine as both (3) a pleasant distraction from the effort of exercise, and (4) nice to have. A therapy dog may enhance some aspects of exercise physiology service delivery.

Physical and Motor Fitness Tests for Older Adults Living in Nursing Homes: A Systematic Review

This systematic review aimed to identify the physical/motor fitness tests for nursing home residents and to examine their psychometric properties. Electronic databases were searched for articles published between January 2005 and October 2021 using MeSh terms and relevant keywords. Of the total of 4196 studies identified, 3914 were excluded based on title, abstracts, or because they were duplicates. The remaining 282 studies were full-text analyzed, and 41 were excluded, resulting in 241 studies included in the review. The most common physical component assessed was muscle strength; 174 (72.2%) studies assessed this component. Balance (138 studies, 57.3%) and agility (102 studies, 42.3%) were the second and third components, respectively, most widely assessed. In this review, we also describe the most used assessment tests for each physical/motor component. Some potentially relevant components such as manual dexterity and proprioception have been little considered. There are few studies assessing the psychometric properties of the tests for nursing home residents, although the data show that, in general, they are reliable. This review provides valuable information to researchers and health-care professionals regarding the physical/motor tests used in nursing home residences, helping them select the screening tools that could most closely fit their study objectives.

Effects of Animal-Assisted Therapy (AAT) in Alzheimer’s Disease: A Case Study

Alzheimer’s disease (AD) is a neurodegenerative disorder, characterized by cortical dementia and irreversibly progressive developments leading to a vegetative state and, finally, to death. Although many aspects of its etiology, diagnosis and treatment still remain obscure and the current approach to the disease mostly suffers from limited and low-efficiency therapeutic means, nevertheless, recent interventions have aimed at improving patients’ quality of life through nonpharmacological approaches, including animal-assisted therapy (AAT), arousing growing interest. In order to assess the physiological and neuropsychological effects of AAT on AD, 24 residents of a rest house in northern Italy were enrolled. The intervention consisted of one 45-minute AAT session per week over ten weeks. Twelve residents (six AD and six non-AD) received AAT and twelve (six AD and six non-AD) were controls. In order to evaluate the physiological and clinical effect of AAT on AD residents, three cardiac parameters, including the systolic and diastolic blood pressure and heart rate, were measured. Moreover, the neurocognitive and depressive states were assessed by the Mini Mental State Examination and the Geriatric Depression Scale, respectively. Analyses were performed by a four-way ANOVA model (including two ways for repeated measures) considering each main effect and interaction possible in the design. Our findings, despite the small sample size, suggest that AAT has a positive significant effect on physiological parameters and neurocognitive impairment, while no effect was observed on the depression level.

Animal-Assisted Intervention in Speech-Language Pathology: Practical, Clinical, and Theoretical Considerations

Interest in animal-assisted interventions within the field of communication sciences and disorders is growing. As more clinicians become interested in engaging in animal-assisted therapy (AAT) and more researchers begin to study its potential benefits, it will be critical for all stakeholders to demonstrate knowledge of the standards and qualifications for service delivery as well as the challenges that must be met in developing an evidence base for clinical practice. This review highlights some of the foundational information relevant to AAT in the context of speech-language pathology.

Extended-Spectrum Beta-Lactamase-Producing and Carbapenem-Resistant Enterobacterales in Companion and Animal-Assisted Interventions Dogs

Animal-assisted interventions (AAIs) are being implemented in many countries for the beneficial effects they have on humans. Patients involved in AAI are often individuals at greater risk of acquiring infections, and these activities involve close contact between humans and animals, as is the case with humans living with a pet. The spread of multidrug-resistant Enterobacterales is a serious problem for human health; an integrated One Health strategy is imperative to combat this threat. Companion dogs can be a reservoir of multidrug-resistant pathogens, and animal-to-human transmission could occur during AAI sessions. The aim of this review was to collect the available data on the carriage of extended-spectrum beta-lactamase-producing and carbapenem-resistant Enterobacterales in companion dogs and in an AAI context. Several papers have generally addressed the issue of microbial transmission during AAIs. Studies on the intestinal carriage of extended-spectrum beta-lactamase and/or carbapenem-resistant Enterobacterales have mainly been conducted in companion animals while few data are available on the carriage in dogs participating in AAI sessions. This review aims to draw attention to the antibiotic resistance problem in a One Health context and to the importance of extending infection control measures to this human-animal interface, to keep the balance of benefits/risks for AAIs shifted towards the benefits of these activities.

The Research of Standardized Protocols for Dog Involvement in Animal-Assisted Therapy: A Systematic Review

Dogs are considered the most important species involved in animal-assisted therapy (AAT), and the scientific literature focuses on the benefits linked to the involvement of dogs in various therapeutic areas. In this study, we carried out a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, exploring the scientific literature from the last 5 years (2016-2021) on three databases (PubMed, Scopus, and Web of Science) to highlight the characteristics of the dogs involved in AATs. Based on the scientific literature relevant to such dogs, we considered different parameters (i.e., number, age, sex, breed, temperament, methods of choice and training, health status, research goals, and activities with dogs) to include studies in our paper. After screening 4331 papers identified on the searched databases, we selected 38 articles that met the inclusion criteria. Analysis of the included articles showed that the characteristics of the dogs were neglected. Our findings indicated a lack of information about the dogs, as well as the absence of standardized and univocal criteria for dog selection, training programs, and health protocols.

Healthy, Active Aging for People and Dogs

Dogs act as companions who provide us with emotional and physical support. Their shorter lifespans compel us to learn about the challenges and gifts of caring for older individuals. Our companion dogs can be exemplars of healthy or unhealthy aging, and sentinels of environmental factors that might increase or decrease our own healthy lifespan. In recent years, the field of aging has emphasized not just lifespan, but healthspan—the period of healthy, active lifespan. This focus on healthy, active aging is reflected in the World Health Organization's current focus on healthy aging for the next decade and the 2016 Healthy Aging in Action initiative in the US. This paper explores the current research into aging in both people and companion dogs, and in particular, how the relationship between older adults and dogs impacts healthy, active aging for both parties. The human-dog relationship faces many challenges as dogs, and people, age. We discuss potential solutions to these challenges, including suggestions for ways to continue contact with dogs if dog ownership is no longer possible for an older person. Future research directions are outlined in order to encourage the building of a stronger evidence base for the role of dogs in the lives of older adults.

Personalized treatment interventions: nonpharmacological and natural treatment strategies in Alzheimer's disease

Introduction: Alzheimer's disease (AD) is a slow, irreversible, progressive, complex, and fatal neurodegenerative disorder. Available pharmacological treatment, known for almost two decades, does not cure the disease, but only alleviates the symptoms, with various efficacy and different side effects. Therefore, there is an unmet need to find other person-centered or personalized approaches to treat AD.Areas covered: This article describes the application of precision medicine-like approaches utilizing nonpharmacological treatment strategies and the use of natural products in personalized care for patients with AD.Expert opinion: Due to the heterogeneity of disease symptoms, somatic conditions, and patient preferences, there is definitely no "one size fits all" intervention. Therefore, individualized treatment choice is based on dementia stage, medical and psychiatric comorbidity, leading symptoms, patient preferences, and remaining capacity of the patient. In the absence of disease-modifying agents, a patient-centered, multidisciplinary team approach appears to be the best option to alleviate the heavy symptomatic burden in this unfortunate population. Hence, appropriate interventions can be offered along the AD continuum, while a better understanding of personal characteristics might help in establishing optimal individualized treatment, as well as its duration and intensity, to deliver interventions in the most effective ways.