Systematic review of non-pharmacologic interventions to delay functional decline in community-dwelling patients with dementia

Abstract

Objectives: Older adults with dementia experience progressive functional decline, which contributes to caregiver burden and nursing home placement. The goal of this systematic review was to determine if any non-pharmacologic interventions have delayed functional decline among community-dwelling dementia patients.

Method: We completed a systematic literature review to identify controlled clinical trials reporting the impact of non-pharmacologic interventions on any measure of functional impairment or disability among community-dwelling dementia patients. We included studies that reported any proxy-respondent, self-reported, or performance-based standardized assessments.

Results: We identified 18 published clinical trials that met inclusion criteria and found that study interventions fell into three different groups: occupational therapy, exercise, and multi-faceted (“other”) interventions. The three groups of studies tended to vary systematically regarding the conceptual framework for the disabling process, target of intervention, and type of outcome measure. Approximately half the studies were conducted in the United States with mean sample size of 99 (from 27 to 1131) and follow-up periods between three months and two years. Instruments used to measure functional impairment or disability varied widely with 55 instruments across 18 studies. Nine studies reported a statistically significant improvement in functional decline in the intervention group.

Conclusion: The current literature provides clinical trial evidence that non-pharmacologic interventions can delay progression of functional impairment or disability among community-dwelling dementia patients. The clinical significance of this early evidence is uncertain. These early studies provide rationale for larger and longer-term studies to determine if these interventions are sufficiently potent to delay institutionalization.

Keywords:

• occupational therapy
• physical function
• aged

Acknowledgement

We would like to acknowledge Tom Emmett, MD, MLS, who provided professional assistance with the identification of the relevant literature.

Notes

Notes: ADL, activities of daily living; PICOT, Population, Intervention, Comparison, Outcome, and Time frame; QOL, quality of life.

Notes: ADCS, Alzheimer's Disease Cooperative Study; ADL, activities of daily living; ADSC-COG, Alzheimer's Disease Cooperative Study – Cognitive subscale; AMPS, Assessment of Motor and Process Skills; BCRS, brief cognitive rating scale; BDS, Blessed Dementia Scale; BPSD, Behavioral and Psychological Symptoms of Dementia; CES-D, Center for Epidemiologic Studies depression scale; COPE, Care of Persons with Dementia in their Environment; CSDD, Cornell Scale for Depression in Dementia; DBD, Dementia Behavior Disturbance Scale; DTC, dual-task costs; FAQ, Functional Activities Questionnaire; FR, functional reach; GDS, Global Deterioration Scale; IADL, instrumental activities of daily living; IDDD, Interview for Deterioration in Daily Living Activities; JTT, Jebsen–Taylor total time test; MMSE, mini mental status exam; NH, nursing home; NPI-Q, Neuropsychiatric Inventory Questionnaire; OT, occupational therapy; PHQ-9, Patient Health Questionnaire (9); PR, performance rate; QOL-AD, Quality of Life – Alzheimer's Disease; RRS, Relative's Stress Scale; SBI-C, Spontaneous Behavior Interview (9); SCS, social competence scale; SF-36, Short-form (36) Health Survey; SIP, Sickness Impact Profile, RDAD, Reducing Disability in Alzheimer's Disease; SRQ-20, Self-reporting scale (20); STS, sit to stand test; TGUG, Timed up and go test; WHO-QOL-BREF, World Health Organization Quality of Life questionnaire; YPAS, Yale Physical Activity Survey.

Notes: 1RM, 1 rep max test; ADL, activities of daily living; ADCS-ADL, Alzheimer's Disease Cooperative Study – Activities of Daily Living; AMPS, Assessment of Motor and Process Skills; DEM-QOL, Dementia Quality of Life scale; D-QOL, Dementia-Quality of Life; FAQ, Functional Activities Questionnaire; IADL, instrumental activities of daily living; ILS, Independent Living Scale; SF-36, Short-form (36); SIP, Sickness Impact Profile; TGUG, Timed up and go test; YPAS, Yale Physical Activity Survey.