Aromatherapy and Reminiscence Therapy (RT) were the most effective psychosocial interventions for improving quality of life (QoL) in patients with moderate to severe dementia, according to a systemic review published in the International Journal of Geriatric Psychiatry.
There are currently 50 million people with dementia worldwide and treatment options for its moderate to severe forms are limited. The treatments available are tailored to reduce symptoms rather than improve cognition and quality of life. In this systematic review, the researchers wanted to measure the effectiveness of currently available psychosocial interventions to determine whether they improve cognition and quality of life in patients with moderate to severe dementia.
Between January and April 2020, researchers conducted a systemic review (PROSPERO: CRD42020167483) using information from 6 databases to identify randomized controlled trials (RCTs) that investigated the effects of psychosocial interventions on cognitive function and quality of life in patients with dementia measured. A total of 14 RCTs that were carried out between 2000 and 2020 were included in the final analysis.
The RCTs included adult patients (N = 1161) with a specific stage of dementia. If the stage of dementia was not specified, a mean Mini-Mental State Examination Score of 20 or less, a Clinical Dementia Rating Score of at least 2, or a Global Deterioration Scale Score of at least 5 were used to determine whether the patients were the criteria met the criteria for inclusion in the review.
Researchers rated the methods of the studies using the Physiotherapy Evidence Database (PEDro) scale and guidelines on consolidated standards for study reporting.
The 14 included RCTs were carried out in Europe, South America and Asia. The mean PEDro score of the studies was 5.86 on a 10-point scale, 10 had a low risk of bias, 8 were simply blinded, 8 were sufficiently powered and 5 contained a confidence interval.
Of the psychosocial interventions included in the RCTs, 6 used multisensory stimulation (MSS) interventions, 5 used multi-component programs, 2 used exercise programs, and 1 used RT.
Of the MSS interventions that included Snoezelen rooms, robotic animals, music therapy, and aromatherapy, only aromatherapy significantly improved quality of life (P = 0.01; PEDro, 7).
The RCT using RT that was adequately powered (n = 135) and had high quality scores showed that the intervention improved quality of life (P <.01).
In 1 of the 2 RCTs that used an exercise program intervention that had sufficient power and had a PEDro score of 6, the results showed that cycling for 15 minutes daily for 15 months significantly improved cognition.
In 1 out of 5 RCTs that used a multi-component intervention, the results showed that a combination of aerobic exercise, memory games, and music therapy significantly improved cognitive function; however, the study had a small sample size and the quality was low (PEDro, 5; n = 36). In addition, the results of the RCT using a multicomponent exercise and music intervention that had sufficient power and a PEDro score of 6 showed a positive trend in cognitive improvement (P = 0.055).
The researchers found that reminiscence therapy and MSS were associated with robotic animals with increased social engagement and increased positive emotions, respectively. They also found that patient mobility increased in studies with aerobic exercise interventions.
Study limitations included the small number of studies per intervention type, different assessments of quality of life, and the exclusion of studies that used cognitive stimulation therapy because the results of patients with moderate dementia could not be separated from those with mild dementia.
“Different types of current psychosocial interventions can improve the health of people with moderate to severe dementia. However, future research with well-defined and high quality outcome measures with a rigorous study design is needed before recommendations on the use and prescription of MSS, RT, exercise, or multi-component interventions for people with moderate to severe dementia can be made, ”the researchers concluded.
EK Hui, V. Tischler, GHY Wong et al. Systematic overview of current psychosocial interventions for people with moderate to severe dementia. Int J Geriatric Psychiatry. Published online: August 4, 2021. doi: 10.1002 / gps.5554