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Abstract
Although acetylcholinesterase inhibitors (e.g., tacrine, donepezil, rivastigmine, and galantamine) and NMDA receptor antagonists (e.g., memantin) have demonstrated efficacy in the temporal symptomatic control of cognitive decline and daily function in Alzheimer's disease (AD) patients, their effect is not good enough to restore premorbid function, nor is it maintained in the later stages. Therefore, nonpharmacological interventions are being increasingly advocated in order to optimize the cognition, affect and global functioning of AD patients. We reviewed the current nonpharmacological interventions for AD. Nonpharmacological interventions can be divided into two groups. One is cognitive interventions (e.g., Memory rehabilitations, Reality orientation, Reminiscence therapy and so on) and the other is behavioral interventions (e.g., unmet needs interventions, learning and behavioral interventions, environmental vulnerability and reduced stress-threshold interventions). Cognitive interventions are aimed to slow and compensate cognitive decline of AD patients. On the other hand, behavioral interventions are aimed to reduce neuropsychiatric symptoms (depression, anxiety, agitation, wandering, aggression and so on) of AD patients. Although many of the nonpharmacological interventions have proven beneficial for AD patients, their efficacy was still ambiguous. Randomized and controlled study with a larger sample size is needed to confirm efficacy of nonpharmacological interventions.
References
1. Vance DE, Moore BS, Farr KF, Struzick T. Procedural memory and emotional attachment in Alzheimer disease: implications for meaningful and engaging activities. J Neurosci Nurs. 2008. 40:96–102.
2. Yesavage JA, Westphal J, Rush L. Senile dementia: combined pharmacologic and psychologic treatment. J Am Geriatr Soc. 1981. 29:164–171.
3. Heiss WD, Kessler J, Mielke R, Szelies B, Herholz K. Longterm effects of phosphatidylserine, pyritinol, and cognitive training in Alzheimer's disease. A neuropsychological, EEG, and PET investigation. Dementia. 1994. 5:88–98.
4. Rothi LJ, Fuller R, Leon SA, Kendall D, Moore A, Wu SS, Crosson B, Heilman KM, Nadeau SE. Errorless practice as a possible adjuvant to donepezil in Alzheimer's disease. J Int Neuropsychol Soc. 2009. 15:311–322.
5. Clare L, Wilson BA, Carter G, Breen K, Gosses A, Hodges JR. Intervening with everyday memory problems in dementia of Alzheimer type: an errorless learning approach. J Clin Exp Neuropsychol. 2000. 22:132–146.
6. Kixmiller JS. Evaluation of prospective memory training for individuals with mild Alzheimer's disease. Brain Cogn. 2002. 49:237–241.
7. Provencher V, Bier N, Audet T, Gagnon L. Errorless-based techniques can improve route finding in early Alzheimer's disease: a case study. Am J Alzheimers Dis Other Demen. 2008. 23:47–56.
8. Ruis C, Kessels RP. Effects of errorless and errorful face-name associative learning in moderate to severe dementia. Aging Clin Exp Res. 2005. 17:514–517.
9. Metzler-Baddeley C, Snowden JS. Brief report: errorless versus errorful learning as a memory rehabilitation approach in Alzheimer's Disease. J Clin Exp Neuropsychol. 2005. 27:1070–1079.
10. Glisky EL, Schacter DL, Tulving E. Learning and retention of computer-related vocabulary in memory-impaired patients: method of vanishing cues. J Clin Exp Neuropsychol. 1986. 8:292–312.
11. Glisky E, Schacter DL. Acquisition of domain-specific knowledge in patients with organic memory disorders. J Learn Disabil. 1988. 21:333–339. 351
12. Diesfeldt HF, Smits JC. Faces get names-cognitive training for psychogeriatric patients for remembering names and faces. Tijdschr Gerontol Geriatr. 1991. 22:221–227.
13. Thoene AI, Glisky EL. Learning of name-face associations in memory impaired patients: a comparison of different training procedures. J Int Neuropsychol Soc. 1995. 1:29–38.
14. Graf P, Schacter DL. Implicit and explicit memory for new associations in normal and amnesic subjects. J Exp Psychol Learn Mem Cogn. 1985. 11:501–518.
15. Kessels RP, de Haan EH. Implicit learning in memory rehabilitation: a meta-analysis on errorless learning and vanishing cues methods. J Clin Exp Neuropsychol. 2003. 25:805–814.
16. McKitrick LA, Camp CJ, Black FW. Prospective memory intervention in Alzheimer's disease. J Gerontol. 1992. 47:337–343.
17. Abrahams JP, Camp CJ. Maintenance and generalisation of object naming training in anomia associated with degenerative dementia. Clin Gerontologist. 1993. 12:57–72.
18. Bier N, Van Der Linden M, Gagnon L, Desrosiers J, Adam S, Louveaux S, Saint-Mleux J. Face-name association learning in early Alzheimer's disease: a comparison of learning methods and their underlying mechanisms. Neuropsychol Rehabil. 2008. 18:343–371.
19. Camp CJ, Stevens AB. Spaced retrieval: a memory intervention for dementia of the Alzheimer's type (AD). Clin Gerontologist. 1990. 10:58–61.
20. Hochhalter AK, Overmier JB, Gasper SM, Bakke BL, Holub RJ. A comparison of spaced retrieval to other schedules of practice for people with dementia. Exp Aging Res. 2005. 31:101–118.
21. Lee SB, Park CS, Jeong JW, Choe JY, Hwang YJ, Park CA, Park JH, Lee DY, Jhoo JH, Kim KW. Effects of spaced retrieval training (SRT) on cognitive function in Alzheimer's disease (AD) patients. Arch Gerontol Geriatr. 2009. 49:289–293.
22. Hart T, Hawkey K, Whyte J. Use of a portable voice organizer to remember therapy goals in traumatic brain injury rehabilitation: a within-subjects trial. J Head Trauma Rehabil. 2002. 17:556–570.
23. van den Broek MD, Downes J, Johnson Z, Dayus B, Hilton N. Evaluation of an electronic memory aid in the neuro-psychological rehabilitation of prospective memory deficits. Brain Inj. 2000. 14:455–462.
24. Wilson BA, Evans JJ, Emslie H, Malinek V. Evaluation of NeuroPage: a new memory aid. J Neurol Neurosurg Psychiatry. 1997. 63:113–115.
25. Evans JJ, Emslie H, Wilson BA. External cueing systems in the rehabilitation of executive impairments of action. J Int Neuropsychol Soc. 1998. 4:399–408.
26. Teasdale TW, Emslie H, Quirk K, Evans J, Fish J, Wilson BA. Alleviation of carer strain during the use of the NeuroPage device by people with acquired brain injury. J Neurol Neurosurg Psychiatry. 2009. 80:781–783.
27. Wilson BA, Scott H, Evans J, Emslie H. Preliminary report of a NeuroPage service within a health care system. Neuro Rehabilitation. 2003. 18:3–8.
28. Baldelli MV, Pirani A, Motta M, Abati E, Mariani E, Manzi V. Effects of reality orientation therapy on elderly patients in the community. Arch Gerontol Geriatr. 1993. 17:211–218.
29. Spector A, Orrell M, Davies S, Woods B. Reality orientation for dementia. Cochrane Database Syst Rev. 2000. CD001119.
30. O'Donovan S. The memory lingers on. Nurs Elder. 1993. 5:27–31.
31. Spector A, Orrell M, Davies S, Woods RT. Reminiscence therapy for dementia. Cochrane Database Syst Rev. 2000. CD001120.
32. Woods B, Spector A, Jones C, Orrell M, Davies S. Reminiscence therapy for dementia. Cochrane Database Syst Rev. 2005. CD001120.
33. Lyketsos CG, Steele C, Baker L, Galik E, Kopunek S, Steinberg M, Warren A. Major and minor depression in Alzheimer's disease: prevalence and impact. J Neuropsychiatry Clin Neurosci. 1997. 9:556–561.
34. Stern Y, Tang MX, Albert MS, Brandt J, Jacobs DM, Bell K, Marder K, Sano M, Devanand D, Albert SM, Bylsma F, Tsai WY. Predicting time to nursing home care and death in individuals with Alzheimer disease. JAMA. 1997. 277:806–812.
35. Yaffe K, Fox P, Newcomer R, Sands L, Lindquist K, Dane K, Covinsky KE. Patient and caregiver characteristics and nursing home placement in patients with dementia. JAMA. 2002. 287:2090–2097.
36. Briesacher BA, Limcangco MR, Simoni-Wastila L, Doshi JA, Levens SR, Shea DG, Stuart B. The quality of antipsychotic drug prescribing in nursing homes. Arch Intern Med. 2005. 165:1280–1285.
37. Sink KM, Holden KF, Yaffe K. Pharmacological treatment of neuropsychiatric symptoms of dementia: a review of the evidence. JAMA. 2005. 293:596–608.
38. Schneider LS, Dagerman KS, Insel P. Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials. JAMA. 2005. 294:1934–1943.
39. Wang PS, Schneeweiss S, Avorn J, Fischer MA, Mogun H, Solomon DH, Brookhart MA. Risk of death in elderly users of conventional vs. atypical antipsychotic medications. N Engl J Med. 2005. 353:2335–2341.
40. Ayalon L, Gum AM, Feliciano L, Arean PA. Effectiveness of nonpharmacological interventions for the management of neuropsychiatric symptoms in patients with dementia: a systematic review. Arch Intern Med. 2006. 166:2182–2188.
41. Palmer CV, Adams SW, Bourgeois M, Durrant J, Rossi M. Reduction in caregiver-identified problem behaviors in patients with Alzheimer disease post-hearing-aid fitting. J Speech Lang Hear Res. 1999. 42:312–328.
42. Snyder M, Egan EC, Burns KR. Efficacy of hand massage in decreasing agitation behaviors associated with care activities in persons with dementia. Geriatr Nurs. 1995. 16:60–63.
43. Feil NW. Group therapy in a home for the aged. Gerontologist. 1967. 7:192–195.
44. Hitch S. Cognitive therapy as a tool for caring for the elderly confused person. J Clin Nurs. 1994. 3:49–55.
45. Neal M, Briggs M. Validation therapy for dementia. Cochrane Database Syst Rev. 2003. CD001394.
46. Kragt K, Holtkamp CC, van Dongen MC, van Rossum E, Salentijn C. The effect of sensory stimulation in the sensory stimulation room on the well-being of demented elderly. A cross-over trial in residents of the R.C. Care Center Bernardus in Amsterdam. Verpleegkunde. 1997. 12:227–236.
47. Holtkamp CC, Kragt K, van Dongen MC, van Rossum E, Salentijn C. Effect of snoezelen on the behaviour of demented elderly. Tijdschr Gerontol Geriatr. 1997. 28:124–128.
48. Hope KW. The effects of multisensory environments on older people with dementia. J Psychiatr Ment Health Nurs. 1998. 5:377–385.
49. Hope K. Using multi-sensory environments with older people with dementia. J Adv Nurs. 1997. 25:780–785.
50. Baker R, Holloway J, Holtkamp CC, Larsson A, Hartman LC, Pearce R, Scherman B, Johansson S, Thomas PW, Wareing LA, Owens M. Effects of multi-sensory stimulation for people with dementia. J Adv Nurs. 2003. 43:465–477.
51. Guetin S, Portet F, Picot MC, Pommie C, Messaoudi M, Djabelkir L, Olsen AL, Cano MM, Lecourt E, Touchon J. Effect of music therapy on anxiety and depression in patients with Alzheimer's type dementia: randomised, controlled study. Dement Geriatr Cogn Disord. 2009. 28:36–46.
52. Gerdner LA, Swanson EA. Effects of individualized music on confused and agitated elderly patients. Arch Psychiatr Nurs. 1993. 7:284–291.
53. Ragneskog H, Asplund K, Kihlgren M, Norberg A. Individualized music played for agitated patients with dementia: analysis of video-recorded sessions. Int J Nurs Pract. 2001. 7:146–155.
54. Cohen-Mansfield J, Werner P. Management of verbally disruptive behaviors in nursing home residents. J Gerontol A Biol Sci Med Sci. 1997. 52:M369–M377.
55. Clark ME, Lipe AW, Bilbrey M. Use of music to decrease aggressive behaviors in people with dementia. J Gerontol Nurs. 1998. 24:10–17.
56. Ballard CG, O'Brien JT, Reichelt K, Perry EK. Aromatherapy as a safe and effective treatment for the management of agitation in severe dementia: the results of a double-blind, placebo-controlled trial with Melissa. J Clin Psychiatry. 2002. 63:553–558.
57. Snow LA, Hovanec L, Brandt J. A controlled trial of aromatherapy for agitation in nursing home patients with dementia. J Altern Complement Med. 2004. 10:431–437.
58. Lin PW, Chan WC, Ng BF, Lam LC. Efficacy of aromatherapy (Lavandula angustifolia) as an intervention for agitated behaviours in Chinese older persons with dementia: a cross-over randomized trial. Int J Geriatr Psychiatry. 2007. 22:405–410.
59. Lee SY. The effect of lavender aromatherapy on cognitive function, emotion, and aggressive behavior of elderly with dementia. Taehan Kanho Hakhoe Chi. 2005. 35:303–312.
60. MacMahon S, Kermode S. A clinical trial of the effect of aromatherapy on motivational behaviour in a dementia care setting using a single subject design. Aust J Holist Nurs. 1998. 5:47–49.
61. Nguyen QA, Paton C. The use of aromatherapy to treat behavioural problems in dementia. Int J Geriatr Psychiatry. 2008. 23:337–346.
62. Gray SG, Clair AA. Influence of aromatherapy on medication administration to residential-care residents with dementia and behavioral challenges. Am J Alzheimers Dis Other Demen. 2002. 17:169–174.
63. Bakke BL, Kvale S, Burns T, McCarten JR, Wilson L, Maddox M, Cleary J. Multicomponent intervention for agitated behavior in a person with Alzheimer's disease. J Appl Behav Anal. 1994. 27:175–176.
64. Feliciano L, Vore J, LeBlanc LA, Baker JC. Decreasing entry into a restricted area using a visual barrier. J Appl Behav Anal. 2004. 37:107–110.
65. Heard K, Watson TS. Reducing wandering by persons with dementia using differential reinforcement. J Appl Behav Anal. 1999. 32:381–384.
66. Moniz-Cook E, Woods RT, Richards K. Functional analysis of challenging behaviour in dementia: the role of superstition. Int J Geriatr Psychiatry. 2001. 16:45–56.
67. Lovell BB, Ancoli-Israel S, Gevirtz R. Effect of bright light treatment on agitated behavior in institutionalized elderly subjects. Psychiatry Res. 1995. 57:7–12.
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