Leeds Institute of Health Sciences FACULTY OF MEDICINE AND HEALTH A Systematic Review of Non-Drug Treatments for Dementia Claire Hulme Judy Wright Tom Crocker Yemi Oluboyede Charles Thackrah Building University of Leeds 101 Clarendon Road Leeds, United Kingdom LS2 9LJ www.leeds.ac.uk/lihs
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A Systematic Review of Non-Drug Treatments for Dementia
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Leeds Institute of Health SciencesFACULTY OF MEDICINE AND HEALTH
A Systematic Review of Non-Drug Treatments for Dementia
Claire Hulme
Judy Wright
Tom Crocker
Yemi Oluboyede
Allan House
July 2008
Charles Thackrah BuildingUniversity of Leeds101 Clarendon RoadLeeds, United KingdomLS2 9LJ
and shuffling when walking) (Yuhas et al 2006). Progression is more
rapid than Alzheimer’s disease but short term memory is usually
good. Those with this type of dementia can show marked
fluctuations in alertness or cognition from hour to hour or week to
week – characterised by confusion during which it is difficult to
concentrate and complete tasks. Likely psychotic symptoms include
paranoia, delusions and hallucinations which can be disruptive.
People with Lewy bodies dementia are at risk of falls because of lack
of an effective righting reflex and may experience restless leg
syndrome which can interfere with sleep (Yuhas et al 2006).
Frontal temporal dementia is typically exhibited in those with a
group of rare neurological disorders affecting the frontal and
anterior temporal lobes of the brain; these include Pick’s disease,
frontal lobe degeneration, and dementia associated with motor
neuron disease (Yuhas et al 2006). It is likely to affect people under
65 and is characterised by gradual onset of changes in personality,
social behaviour and language, dependent on whether damage has
occurred in the left side (language) or right side (behaviour) of the
front of the brain (Yuhas et al 2006). The later stages are
Leeds Institute of Health Sciences July 2008
15
characterised by difficulties with speech and language, memory loss
and oral fixations. Behavioural and psychological disturbances are
common (Yuhas et al 2006).
In the UK there is increasing focus on dementia. A recent report
from the House of Commons Committee of Public Accounts
acknowledged that dementia, despite its financial and human
impact, has not received the same priority status as other diseases.
It is estimated that in England alone late-onset dementia costs some
£14.3 billion per year. This estimate includes the cost of care home
accommodation (£5.72 billion, 40%) and an estimated saving to the
taxpayer of £5.29 billion (37%) from the contribution made by
informal carers (the NHS and social care make up the remainder;
£1.14 billion 8% and £2.15 billion 15% respectively)7.
The House of Commons report highlights the heavy burden carried
by those caring for relatives with dementia at home. Indeed
informal carers8 deliver most of the care to people with dementia in
the UK and many are elderly and frail themselves9. A National
Dementia Strategy is planned for 200810.
Aim
The aim of this report is to help informal carers who want ideas
about non-drug approaches for dementia, that they might try or that
they could try to access.
Using a two part process, initially a systematic review was carried
out in order to addresses the following questions:
7 http://www.publications.parliament.uk/pa/cm200708/cmselect/cmpubacc/228/228.pdf8 Informal carers are people who look after a relative or friend who needs support because of age, physical or learning disability or illness, including mental illness.9 http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=546
What non-drug treatments work and what do they work for?
What non-drug treatments might work and what for?
What non-drug treatments do not work?
The second part of the process searched the websites of four
national (UK, USA and Australia) and international (Europe)
dementia organisations to identify recommendations or suggestions
for non-drug approaches for dementia. In each case the strategies
identified from the websites were aligned with the non-drug
treatments identified in the systematic review to produce a series of
suggestions or ideas for informal carers about non-drug approaches
for dementia, that they might try or access.
Methodology
The systematic review has been carried out by a team from the
Institute of Health Sciences, University of Leeds.
Literature Search
The search strategy was developed by the review team at the
University of Leeds. Literature searches of electronic databases and
websites were then carried out. Comprehensive searches of the
following databases were carried out on 7th November 2007:
AMED (via OVID host)
CINAHL (via OVID host)
EMBASE (via OVID host)
MEDLINE (via OVID host)
PSYCINFO (via OVID host)
Cochrane Library of Systematic Reviews (via Wiley host)
DARE (via Wiley host)
The search strategies used can be found in Appendix 1.
Inclusion Criteria
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17
1. Systematic reviews only (not reviews) including at least one
randomised controlled trial of a non-drug intervention
2. English language
3. Non-drug treatments
4. The primary purpose of the review is to evaluate the
effectiveness or efficacy evidence of one or more non-drug
treatments for dementia
5. Reviews published from 2001 onwards
Exclusion Criteria
1. Management of dementia in acute settings
2. Management of dementia in long term care
facilities/residential care settings
3. Assessment of dementia
4. Screening for dementia
5. Prevention of dementia
6. Guidelines for dementia
7. Herbal remedies/vitamin supplements
8. Generic reviews in gerontology
9. Interventions for caregivers (this refers to interventions for
carers per se rather than interventions that carers can implement to
help the person they care for)
The search yielded 784 unique references. Two stages of screening
were used to determine which studies should be included in the
review. Titles and abstracts of all 784 references were first
screened. This first screening identified 114 potentially relevant
papers. Full paper screening of the 114 references identified 35
papers to be included in the review representing 33 studies. Of the
remaining, six provided background detail, 71 were excluded, and
two were unobtainable in the time available. Reasons for exclusion
are shown in box 1.
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Box 1: Reasons for Exclusion from the Review
Not systematic reviews only (not reviews) including at least one randomised controlled trial of a non-drug intervention
57
Not English language 4The primary purpose of the review is not to evaluate the effectiveness or efficacy evidence of one or more non-drug treatments for dementia
6
Guidelines 2Not received in time to be included 2Précis of a review only 1Withdrawn 1Background only 6Total 79
Quality Appraisal
Data relating to the scope of this review was extracted from each
study using the National Institute of Clinical Excellence (NICE) data
Boredom can be addressed using a range of activities (see
activities subsection)
Excess energy and boredom may be addressed by increasing
physical activity (see activities subsection).
Wandering
Wandering may be due to a variety of cause including a changed
environment, a loss of memory, excess energy, boredom, confusion
of day with night, agitation, or discomfort or pain174. It may be the
result of stress or anxiety or the side effects of medication175
Agitation and anxiety are dealt with in a separate subsection and
the reader should consult suggestions in those sections along with
the suggested techniques described here.
Accessing interventions:
Carers might consider accessing training courses for
behaviour management techniques locally through their health care
providers. Carers can also ask for an assessment of key factors that
may improve challenging behaviour in those they are caring for. The
NICE clinical guidelines are clear that that people with dementia
who develop non-cognitive symptoms should be offered an
assessment at the earliest opportunity that includes behavioural
and functional analysis. As a result of this assessment an
individually tailored care plan is formulated that can help carers.
People caring for a person with dementia might want to
access music therapy and several organisations provide group (and
individual) music activities. Details of activities available locally are
accessible on websites such as http://www.nordoff-robbins.org.uk/or
may be available through local health care providers. If there is a
particular time of day when the person being cared for becomes
agitated try scheduling music therapy just before that time176.174 http://www.alzheimers.org.au/content.cfm?infopageid=4465175 http://www.alz.org/living_with_alzheimers_wandering_behaviors.asp
Matrix 1b. Interventions and Symptoms: 0=Evidence of effectiveness; 1= No evidence of effectiveness; 2=inconclusive evidence
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Mood Neuropsychiatric Symptoms
Nutrition
Psychological Symptoms
Quality of Life / Well-being
Recall Sleep Social Behaviour
Wandering
Acupuncture
Animal Assisted Therapy
2 2
Aromatherapy 2 2
Behaviour Management
2 1
Cognitive stimulation /
rehabilitation / training
2 2
Counselling 1
Environment Manipulation
2
Light Therapy 2 2 2
Massage / Touch 0 2Music / music
therapy0 0 0 0
Physical activity / exercise
0 0 0
Reality orientation 1Reminiscence
therapy2
Snoezelen / multi-sensory
stimulation
1 2 2 2
TENS
Validation therapy
2
120
Table 1. Acupuncture: Key Characteristics of included systematic reviews (including at least one RCT). General reviews that included Author,
YearOverall
assessment of the review
Research Question
Years covered
Search terms used
Databases searched
No of studies
reviewed
Author’s Conclusions on Counselling Study
Comments
Peng 2007 ++ What is the efficacy and
possible adverse effects of
acupuncture therapy for
treating vascular dementia?
Search carried
out February 2007. No details of
date restriction
s
Acupunct* Specialised Register contained records from : CENTRAL,
MEDLINE, EMBASE, PsycINFO, CINAHL,
SIGLE, LILACS, ISTP, INSIDE, plus these,
on-going trials
0 There is currently no evidence available from sufficiently high quality
RCTs to allow assessment of the
efficacy of acupuncture in the treatment of vascular dementia
Clear search criteria
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Table 2a . Animal Assisted Therapy (AAT): Key Characteristics of included systematic reviews (including at least one RCT). Author,
YearOverall assessment of
the review
Research Question
Years covered
Search terms used
Databases searched
No of studies review
ed
Author’s Conclusions Comments
Filan 2006
+ To review studies that have
investigated whether AAT has a
measurable beneficial effect for
people with dementia and
specifically upon behavioural and
psychological symptoms of
dementia
1960-2005 Animal assisted therapy, pet and
dementia
MEDLINE, PsychInfo,
CINAHL
11 AAT appears to offer promise as a psychosocial intervention for people with dementia. The
optimal frequencies and duration of AAT sessions, as well as the optimal format of
such sessions, need systematic study.
Studies considered a number of interventions including ‘pet
visits’, introduction of a resident dog and introduction
of aquaria. Results were reported in terms of:
reducing agitation and/or aggression;
promoting social behaviour;improving nutrition
The authors point to several limitations in the studies reviewed; these include
potential bias (participants have a prior history of positive
interaction with animals), small sample sizes, unit of randomisation, duration of
impact unclear
No details of how many studies were identified
originally or screening criteriaSome aspects of study design
not clear – for example randomisation; small sample
sizes, selection criteria is likely to overestimate results
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Table 2b . Animal Assisted Therapy (AAT): Key Characteristics of included systematic reviews (including at least one RCT). General Review Including AATAuthor,
YearOverall assessment of
the review
Research Question
Years covered
Search terms used
Databases searched
No of AAT
studies review
ed
Author’s Conclusions Comments
Cohen-Mansfield 2001
- Considers inappropriate behaviours in dementia; a
literature search on the impact of non-pharmacological interventions (to
address the issues of understanding of the interventions, their effects and their feasibility)
No dates given
No details given PsycLIT, MEDLINE,
and a nursing
subset of MEDLINE
83 Pet therapy: 3 studies, all report improvements
The volume of studies included in the overall review mean
that some, but not all of the studies are described, but all
are given equal weight. Methodological issues are
presented within the discussion section, these
relate to diverse measurement methods, criteria for success, screening procedures, control procedures and treatment of
failures. Little or no account is taken of study design (RCT,
case study etc).
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Table 3a. Aromatherapy: Key Characteristics of included systematic reviews (including at least one RCT). Author,
YearOverall assessment of
the review
Research Question
Years covered
Search terms used
Databases searched No of studies review
ed
Author’s Conclusions
Comments
Thorgrimsen 2003
/ 2006 (two
papers reporting the same
study)
++ What is the evidence for the
efficacy of aromatherapy as
an intervention for people with dementia?
Search carried out April 2006
Aroma*, complementary
therap*, alternative
therap*, essential oil*
Specialised Register contained records from :
CENTRAL, MEDLINE, EMBASE, PsycINFO, CINAHL, SIGLE, ISTP, INSIDE, Aslib Index to theses, Dissertation
Abstract (USA), http://clinicalstudies.info
.nih.gov/, National Research Register, ClinicalTrails.gov,
LILACS, http://www.forestclinical
trials.com, ClinicalStudyResults.org
, http://lillytrials.com/inde
x.shtml, ISRCTN Register, IPFMA Clinical
Trials Register, Lundbeck Trial Registry;
journals: Complementary
Therapies in Medicine, Complementary
Therapies in Nursing and Midwifery
2 (all RCTs)
The additional analyses (of only
one RCT) conducted revealed a statistically significant
treatment effect in favour of the
aromatherapy intervention on
measures of agitation and
neuropsychiatric symptoms, but
there were several methodological
difficulties with the study.
Clear review with comprehensive description of methodology, literature and findings. The conclusions are
Table 3b. Aromatherapy: Key Characteristics of included systematic reviews (including at least one RCT). General Reviews that included Aromatherapy
Author,Year
Overall assessment of
the review
Research Question
Years covered
Search terms used
Databases searched No of aromatherapy studies review
ed
Author’s Conclusions
Comments
Robinson 2006 / 2007 (two
papers reporting
same study)
++ To determine the clinical and cost
effectiveness and acceptability of
non-pharmacological interventions to
reduce wandering dementia
Search carried out up to and including 31 March
2005
Full details of search terms contained in
appendix
Included Cochrane Library, MEDLINE, EMBASE, Central
CINAHL, Social Science Citation Index, Science
Citation Index, PsycINFO, ADEAR, National Research
Register, ETHX database, Bioethicsweb, ISTP, ZETOC,, Journal of Dementia Care (1999-
2004), Dementia (2002-4), personal contact
with specialists in the field
2 Overall no robust evidence of the
efficacy the evidence deemed
to be of low quality. Two RCTs;
one showed participants
receiving essential oils showed less
wandering behaviour (marginal statistical
significance); the other found no
difference.
Clear review with comprehensive description of methodology, literature and findings. The conclusions are
in line with the findings.
Diamond 2003
- To review use of alternative
substances to ameliorate the
cognitive, psychiatric and
behavioural symptoms of
dementia
1982-2002 Numerous terms listed in paper – but no dementia terms mentioned
Medline, Research Council for
Complementary Medicine, PsycINFO,
Ingenta plc, Cochrane Database of Systematic
Reviews
7 The studies among persons with
dementia indicate that aromatherapy
may have moderately
beneficial effects. Better controlled
studies with larger sample sizes are
needed to evaluate the effect of
aromatherapy on the affect and behaviour of persons with
dementia
Likely to overestimate results as study quality is not
assessed – all appear to have been given equal weight
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Table 4. Behaviour Management: Key Characteristics of included systematic reviews (including at least one RCT). General Reviews that included Individualised Behaviour Management
Author,Year
Overall assessmen
t of the review
Research Question Years covered Search terms used Databases searched No of studies
reviewed
Author’s Conclusions Comments
Robinson 2006 /
2007 (two papers on
same study)
++ To determine the clinical and cost effectiveness and
acceptability of non-pharmacological
interventions to reduce wandering dementia
Search carried out up to and including 31 March 2005
Full details of search terms contained in
appendix
Included Cochrane Library, MEDLINE, EMBASE,
Central CINAHL, Social Science Citation Index, Science Citation Index,
PsycINFO, ADEAR, National Research Register, ETHX
atabase, Bioethicsweb, ISTP, ZETOC,, Journal of Dementia Care (1999-2004), Dementia (2002-4), personal contact with specialists in the field
1 This study did not provide evidence that the intervention was
effective in preventing/reducing
wandering
Clear review with comprehensive description of methodology, literature and findings. The conclusions are in
line with the findings.
Livingston
2005
+ A systematic review of
psychological approaches to the management of neuropsychiatric
symptoms of dementia with the
aim of making evidence based
recommendations about the use of
these interventions
Electronic database up to July 2003,
Hand searched
three journal
during 10 year period up to July
2003
terms encompassing
individual dementias and interventions –
no further details given
Electronic databases; reference lists from
individual and review articles, Cochrane Library plus hand
searched three journals (titles not given)
25 25 papers report on non-dementia
specific psychological therapies for patients with
dementia, nearly all examined behavioural
management techniques. The
studies were judged to be
relatively high quality. The
authors report that the findings of the larger RCT were consistent and
positive, and the effects lasted for
months
Overall a comprehensive review that is let down by lack of detail in the search strategy
which means it is not replicable. In addition, due to
the very large number of papers included in the review (162), other than highlighting
the RCTs it is difficult to determine study design or
details such as sample characteristics or setting.
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Table 4 (cont). Behaviour Management: Key Characteristics of included systematic reviews (including at least one RCT). General Reviews that included Individualised Behaviour Management
Author,Year
Overall assessmen
t of the review
Research Question Years covered Search terms used Databases searched No of studies
reviewed
Author’s Conclusions Comments
Verkaik 2005
+ The effect of psychosocial methods
on depressed, aggressive and apathetic
behaviours of people with dementia
Search carried out from
September 2002 to
February 2003
Numerous terms included and listed
Pubmed, Cochrane CENTRAL/CCTR, Cochrane
Database of Systematic Reviews, PsychINFO, EMBASE, CINAHL,
1 There is limited evidence (one high quality RCT) that
people with probable Alzheimer’s disease living at home with depression are less
depressed when their caregivers are trained in
using Behaviour therapy-pleasant events or behaviour therapy-problem solving rather
than given standard information from a
therapist or no information/training.
Overall a comprehensive review; however, there is no discussion of the
strength of evidence for no effect / negative effect - only positive effect
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Table 5a. Cognitive Stimulation Therapy/Cognitive Rehabilitation/Cognitive Training: Key Characteristics of included systematic reviews (including at least one RCT). Author,
YearOverall
assessment of the review
Research Question Years covered Search terms used Databases searched No of studies
reviewed
Author’s Conclusions Comments
Clare 2007 ++ To evaluate the effectiveness and impact of cognitive training and cognitive rehabilitation interventions aimed at
improving memory and other aspects of
cognitive functioning for people in the early stages of Alzheimer’s
disease or vascular dementia
Search carried out April 2006 and September
2006
Numerous, listed in paper
Specialised Register contained records from : CENTRAL,
MEDLINE, EMBASE, PsycINFO, CINAHL, SIGLE,
ISTP, INSIDE plus Theses and on-going trials
9 (all RCTs)
The available evidence remains limited, but there is still no indication
of any significant effects from cognitive training.
The use of standardised neuropsychological measures may result in positive effects on daily
living capabilities going unrecognised.It is not possible at to draw
conclusions about the efficacy of individualised cognitive rehabilitation
interventions for people with early stage dementia due to lack of RCTs.
Comprehensive review with clear search
strategy, terms and criteria but as noted by the authors The use of
standardised neuropsychological
measures may result in positive effects on daily living capabilities going
unrecognised.
Grandmaison 2003
+ To review the evidence on the
efficacy of stimulation
strategies or programmes with the AD population
As indicated by database
Numerous search terms
outlined in textClear
inclusion/exclusion criteria
Medline (1971), PsychINFO (1887-2001)
17 The results suggest that it is possible to stimulate memory in AD. The errorless learning,
spaced retrieval, and vanishing clues techniques,
together with the dyadic approach seem to present the
best training methods for patients with AD. But there is
a need for more RCTs to validate this treatment
approach.
Comprehensive review but inclusion
of only two databases for the search may have
led to the exclusion of pertinent
studies.As the authors
suggest, whilst the evidence suggests positive results the majority of studies
contain small sample numbers
making identification of
statistically significant
improvements difficult.
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Table 5a. Cognitive Stimulation Therapy/Cognitive Rehabilitation/Cognitive Training: Key Characteristics of included systematic reviews (including at least one RCT).
Author,Year
Overall assessmen
t of the review
Research Question Years covered Search terms used Databases searched No of studies
19 Cognitive training evidenced promise in the treatment of AD, with primarily medium effect sizes for learning memory, executive functioning, ADL, general cognitive problems, depression, self-rated general functioning. Restorative strategies demonstrated the greatest effect on functioning. Limitations: small number of well controlled studies; small sample numbers and difficulties associated with outcome measures. Evidence of maintenance of gains is based on only six papers.
Overall a well present and clear review and analysis. However, it is interesting to note that studies identified as higher quality ‘painted a less optimistic picture of efficacy’. The studies come under the cognitive training umbrella but include a diverse range of interventions (including reality orientation and reminiscence therapy).
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Table 5b. Cognitive Stimulation Therapy/Cognitive Rehabilitation/Cognitive Training: Key Characteristics of included systematic reviews (including at least one RCT). General Reviews that included Cognitive Stimulation Therapy/Cognitive Rehabilitation/Cognitive Training
Author,Year
Overall assessmen
t of the review
Research Question Years covered Search terms used
Databases searched No of cognition studies reviewed
Author’s Conclusions Comments
Bates 2004 + To investigate the effectiveness of psychological
interventions for people with milder dementing
illness
Search carried out between
April and June 2002
Numerous 15 electronic databases, 10 grey literature sources – details
contained in study appendix
1 The study found no significant improvement
in functional and cognitive ability.
Therefore the review did not find any evidence of the effectiveness of
procedural memory stimulation.
Overall although most studies were excluded on grounds of quality, the
four retained had low sample size and no power calculations which could
overstate positive results
Livingston2005
+ A systematic review of psychological
approaches to the management of neuropsychiatric
symptoms of dementia with the aim of making
evidence based recommendations about
the use of these interventions
Electronic database up to
July 2003, Hand searched three journal
during 10 year period up to July 2003
terms encompassing individual dementias
and interventions – no further details given
Electronic databases; reference lists from
individual and review articles, Cochrane Library plus hand
searched three journals (titles not given)
4 Mostly consistent evidence that cognitive
stimulation therapy improves aspects of
neuropsychiatric symptoms immediately and for some months
afterwards.Three of the four RCTs
showed positive improvements
Overall a comprehensive review that is let down by lack of detail in search
strategy which means it is not replicable. In addition, due to the very large number of papers included in the review (162), other than highlighting the RCTs it is difficult to determine
study design or details such as sample characteristics or setting.
Table 6. Counselling: Key Characteristics of included systematic reviews (including at least one RCT). General reviews that included Counselling
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Author,Year
Overall assessment of
the review
Research Question Years covered
Search terms used
Databases searched No of counselling
studies reviewed
Author’s Conclusions on Counselling Study
Comments
Bates 2004 + To investigate the effectiveness of psychological
interventions for people with milder dementing illness
Search carried out between April and June 2002
Numerous 15 electronic databases, 10 grey literature sources –
details contained in study appendix
1 Effectiveness of the individual counselling
sessions was not demonstrated on the outcome
measures used.
Overall although most studies were excluded on grounds of
quality, the four retained had low sample size and no power
calculations which could overstate positive results
Table 7. Environmental Interventions: Key Characteristics of included systematic reviews (including at least one RCT). General Reviews that included Environmental Interventions
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Author,Year
Overall assessmen
t of the review
Research Question Years covere
d
Search terms used
Databases searched
No of studies reviewed
Authors’ Conclusions Comments
Livingston2005
+ A systematic review of psychological
approaches to the management of neuropsychiatric
symptoms of dementia with the aim of making
evidence based recommendations about
the use of these interventions
Electronic
database up to
July 2003, Hand
searched three journal during 10 year period up to July 2003
terms encompassing
individual dementias and
interventions – no further details
given
Electronic databases;
reference lists from individual
and review articles,
Cochrane Library plus
hand searched three journals
(titles not given)
19 8 studies investigated the effects of changing the visual environment: consistent
evidence from lower grade studies for changing the environment to obscure the
exit.2 studies investigated use of mirrors: inconclusive/inconsistent evidence
3 studies investigated use of signposting: inconclusive/inconsistent evidence
5 studies in group living: inconclusive/inconsistent evidence
I study unlocked doors: inconclusive/inconsistent evidence
Overall a comprehensive review that is let down by lack of detail in search
strategy which means it is not replicable. In addition, due to the very large number of papers included in the review (162), other than highlighting the RCTs it is difficult to determine
study design or details such as sample characteristics or setting.
Cohen-Mansfield 2001
- Considers inappropriate behaviours in dementia; a
literature search on the impact of non-pharmacological interventions (to
address the issues of understanding of the interventions, their effects and their feasibility)
No dates given
No details given
PsycLIT, MEDLINE,
and a nursing
subset of MEDLINE
6 2 studies showed free access to an outdoor area,result in decreased
agitation; 2 studies found a simulated natural environment
after initiation of a reduced stimulation environment.
The volume of studies included in the overall review (n=83)
mean that some, but not all of the studies are described, but
all are given equal weight. Methodological issues are
presented within the discussion section, these
relate to diverse measurement methods, criteria for success, screening procedures, control procedures and treatment of
failures. Little or no account is taken of study design (RCT,
case study etc).
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Table 7 (cont) . Environmental Interventions: Key Characteristics of included systematic reviews (including at least one RCT). General Reviews that included Environmental Interventions
Author,Year
Overall assessmen
t of the review
Research Question Years covere
d
Search terms used
Databases searched
No of studies reviewed
Authors’ Conclusions Comments
Spira 2006 - To critically review the empirical literature on
behavioural interventions to reduce agitation in older adults
with dementia
1970-2004
No details given PsycINFO 6 Overall the 23 reviewed studies collectively provide evidence that warrants optimism regarding the application of behavioural
principles to the management of agitation among older adults with dementia.
Although some of the results of some of the studies are mixed and several studies
revealed methodological shortcomings, many offered innovations that can be used
in future, more rigorously designed, intervention studies.
Wandering and hazardous behaviour: taken together the 6 studies can have clinically meaningful effects on wandering in older adults with dementia; but contradictory
results were obtained concerning the utility of particular stimuli.
Disruptive vocalization: only one single subject case study.
Only one database searched which is likely to have limited papers
identified.The conclusions drawn by the author
suggest the studies collectively provide evidence. Unfortunately the prevalence of single subject and case
study designs together with the majority of studies measuring the occurrence of target behaviours by
direct observation means this evidence is, at best weak and likely to over
estimate the results.
Table 8a. Light Therapy Reviews: Key Characteristics of included systematic reviews (including at least one RCT).
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133
Author,Year
Overall assessment
of the review
Research Question
Years covered Search terms used
Databases searched No of studies
reviewed
Author’s Conclusions Comments
Forbes 2007
++ What recommendations can be made regarding the
efficacy of light therapy in managing
disturbances of sleep,
behaviour, mood and/or
cognition associated with
dementia?
Search carried out December
2005
Bright light*, light box*, light visor*,
dawn-dusk*, phototherapy
(MESH), phototherapy,
“phototherapy”, “light therapy”,
“light treatment”, light*
Specialised Register contained records from : CENTRAL, MEDLINE, EMBASE, PsycINFO,
CINAHL, SIGLE, ISTP, INSIDE, Aslib Index to
theses, Dissertation Abstract (USA),
http://clinicalstudies.info.nih.gov/, National Research
Research Question Years covered Search terms used Databases searched No of studies
reviewed
Author’s Conclusions Comments
Kim 2003 - To evaluate the effects of bright light therapy on the sleep
and behaviour of dementia patients
No clear Not reported Not reported 14 A need clearly exists for well-designed
controlled studies to look at the relationship
among dementia, agitation, sleep-
wakefulness and bright light in community or
nursing home populations.
Limited search methodology is reported and no methodology for data
extraction / selection / synthesis.Database(s) not reported, nor search
terms, number of initial hits or process for selection. Inclusion/exclusion
criteria are reported.Adequate discussion of
methodological problems but divorced from the selection of studies and
results.The lack of reporting of the literature
search and wide inclusion criteria could overestimate effects, however
the authors do not draw any conclusions regarding effects.
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Table 8b. Light Therapy Reviews: Key Characteristics of included systematic reviews (including at least one RCT). General reviews that included Light TherapyAuthor,
YearOverall
assessment of the review
Research Question
Years covered Search terms used Databases searched No of light
studies reviewed
Author’s Conclusions Comments
Cohen-Mansfield 2001
- Considers inappropriate behaviours in dementia; a
literature search on the impact of non-pharmacologic
al interventions
(to address the issues of
understanding of the
interventions, their effects
and their feasibility)
No dates given
No details given PsycLIT, MEDLINE, and a nursing subset of
MEDLINE
7 The results of the 7 studies are
inconclusive, some report a significant decrease and some
report a trend. These differences may stem from differences in
design and measurement or
from differences in population.
The volume of studies included in the overall review mean
that some, but not all of the studies are described, but all
are given equal weight. Methodological issues are
presented within the discussion section, these
relate to diverse measurement methods, criteria for success, screening procedures, control procedures and treatment of
failures. Little or no account is taken of study design (RCT,
case study etc).
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136
Table 9a. Massage and Touch: Key Characteristics of included systematic reviews (including at least one RCT). Author,
YearOverall
assessment of the review
Research Question Years covered Search terms used Databases searched No of studies
reviewed
Author’s Conclusions Comments
Viggo Hansen 2006
++ To assess the effectiveness of a range of massage and touch therapies offered to
patients with dementia
Search carried out July 2005.
No date exclusion
Trials identified from the Specialised Register of the
Cochrane Dementia and Cognitive
Improvement Group using the terms
massage, reflexology, touch,
shiatsu
Specialised Register contained records from : CENTRAL,
MEDLINE, EMBASE, PsycINFO, CINAHL, SIGLE, ISTP, INSIDE, Aslib Index to theses, Dissertation Abstract
(USA), http://clinicalstudies.info.nih.g
ov/, National Research Register, ClinicalTrails.gov,
Table 9b. Massage and Touch: Key Characteristics of included systematic reviews (including at least one RCT). General Reviews that included Massage and Touch
Author,Year
Overall assessmen
t of the review
Research Question Years covered Search terms used Databases searched No of studies
reviewed
Author’s Conclusions Comments
Livingston
2005
+ A systematic review of
psychological approaches to the management of neuropsychiatric
symptoms of dementia with the
aim of making evidence based
recommendations about the use of
these interventions
Electronic database up to July 2003,
Hand searched
three journal
during 10 year period up to July
2003
terms encompassing
individual dementias and interventions –
no further details given
Electronic databases; reference lists from
individual and review articles, Cochrane Library plus hand
searched three journals (titles not given)
3 The authors identify 3 studies in this area only one of which is a RCT. The authors report
no evidence for sustained
usefulness. However, the RCT, comparing calming
music, hand massage, music
followed by massage or music
and massage simultaneously for 10 minutes each,
finds all groups had reduced agitation
relative to comparison group. Effect lasted for 1
hour.
Overall a comprehensive review that is let down by lack
of detail in search strategy which means it is not
replicable. In addition, due to the very large number of
papers included in the review (162), other than highlighting
the RCTs it is difficult to determine study design or
details such as sample characteristics or setting.
Cohen-Mansfield 2001
- Considers inappropriate behaviours in dementia; a
literature search on the impact of non-pharmacological interventions (to
address the issues of understanding of the interventions, their effects and their feasibility)
No dates given
No details given PsycLIT, MEDLINE, and a nursing subset of
MEDLINE
83 Massage touch: 6 studies, one
reported unequivocal
success, the others either a positive
trend, partial effects (physical
and verbal behaviours) or no effect (aggression)
The volume of studies included in the overall review) mean that some, but not all of the studies are described, but all
are given equal weight. Methodological issues are
presented within the discussion section, these
relate to diverse measurement methods, criteria for success, screening procedures, control procedures and treatment of
failures. Little or no account is taken of study design (RCT,
case study etc).
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138
Leeds Institute of Health Sciences July 2008
139
Table10a. Music Therapy Reviews: Key Characteristics of included systematic reviews (including at least one RCT).
Author,Year
Overall assessmen
t of the review
Research Question Years covered Search terms used Databases searched No of studies
reviewed
Author’s Conclusions Comments
Sung 2005 ++ To provide a summary of the current state of knowledge about the effects of preferred music on agitated
behaviours for older people with dementia
and to discuss the implications for future research and practice
Table 10a (cont). Music Therapy: Key Characteristics of included systematic reviews (including at least one RCT).
Author,Year
Overall assessment of
the review
Research Question Years covered Search terms used Databases searched No of studies
reviewed
Author’s Conclusions Comments
Sherratt 2004
+ To review clinical empirical studies
looking at the effects of a variety
of music on the emotional and behavioural
responses in people with dementia
Assume search conducted 2003. No
explicit date exclusion
Music, music therapy, dementia,
review
CINAHL, MEDLINE, EMBASE, PsychINFO,
ClinPSYCH
21 Most studies reported the effects of music to be effective in decreasing a range of challenging behaviours including aggression, agitation, wandering, repetitive vocalizations and irritability. Music was also found to increase reality orientation scores, time spent with one’s meal and social behaviour.
Not clear from table or text of the number of RCTs
A comprehensive review that whilst discussing a number of
methodological issues (including, for example, observational data
collection methods) does not address study design in relation to
assessment of quality
Lou 2001 - To review interventions using music to decrease agitated behaviour of the demented elderly person
1990- to present
(assume 2001)
Music therapy, agitated behaviour, demented elderly
MEDLINE, CINAHL 7 Music can be useful as an intervention to help patients deal with agitated behaviour problems and can increase patients’ quality of life but the overall weakness and limitations in study design are considerable.
Not clear from table or text of the number of RCTs
The review question focus is specifically concerned with
reduction of agitated behaviour. The search strategy is not clear in as
much as inclusion criteria is preferably with demented elderly
and no details are given of the numbers of papers identified in initial screening. Limiting the
search to two databases may have reduced the papers identified
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141
Table 10a (cont). Music Therapy: Key Characteristics of included systematic reviews (including at least one RCT).
Author,Year
Overall assessment of
the review
Research Question Years covered
Search terms used
Databases searched No of music therapy studies
reviewed
Author’s Conclusions on Music Therapy Study
Comments
Nugent 2002 - Examine the use of music and music therapy used for people who have
ADRDs (Alzheimers disease and related
disorders) and display agitated behaviours
1980 – present (assume 2002)
No details given Psychlit, CAIRSS, CINAHL, Dissertation
Abstracts International plus reviewed articles in:
Journal of Music Therapy, Music Therapy
Perspectives, The Australian Journal of Music
Therapy, The British Journal of Music Therapy
19 The review supported the premise that music and music therapy interventions reduce the occurrence and frequency
of agitated behaviours for those with Alzheimer’s
disease and related disorders. Music therapy may prevent extreme forms of agitation.
Wandering and general restlessness reduced
significantly. However, more rigorous designs that include refined measuring tools and
studies that have larger sample sizes are required to
gather more data.
The author’s conclusions are likely to overstate the effectiveness of the
interventions as all studies given equal weight irrespective of study quality. There is insufficient detail or assessment of the quality of the
papers
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142
Table 10b. Music Therapy: Key Characteristics of included systematic reviews (including at least one RCT). General reviews that included Music Therapy
Author,Year
Overall assessment of
the review
Research Question Years covered
Search terms used
Databases searched No of music therapy studies
reviewed
Author’s Conclusions on Music Therapy Study
Comments
Robinson 2006, 2007 (two papers report same
study)
++ To determine the clinical and cost effectiveness and
acceptability of non-pharmacological interventions to
reduce wandering dementia
Search carried out up to and
including 31 March 2005
Full details of search terms contained in
appendix
Included Cochrane Library, MEDLINE, EMBASE,
Central CINAHL, Social Science Citation Index, Science Citation Index, PsycINFO, ADEAR,
National Research Register, ETHX atabase,
Bioethicsweb, ISTP, ZETOC,, Journal of
Dementia Care (1999-2004), Dementia (2002-4),
personal contact with specialists in the field
1 Review found no evidence for the effectiveness of music
therapy; the identified evidence was assessed to be
of low quality. One RCT that showed conflicting evidence based on different measures
Clear review with comprehensive description of methodology, literature and findings. The
conclusions are in line with the findings.
Warner 2006 ++ What are the effects of treatment on
cognitive symptoms of dementia?
What are the effects of treatments on behavioural and psychological symptoms of
dementia?
Assume up to and
including February
2006
Full details of search strategy
contained on BMJ Clinical Evidence
website
Cochrane Database of Systematic Reviews (on
CD-ROM)Medline [see search
strategy]Embase [see search
strategy]Other databases (e.g.
PsycInfo) as appropriateCentre for Reviews and Dissemination (CRD)
websiteDatabase of Abstracts of
Reviews of Effects (DARE) online database
Health Technology Assessment (HTA) online
databaseNational Institute for Health and Clinical
Excellence (NICE) websiteTRIP online database
3 Music therapy has unknown effectiveness.
One RCT found that music based exercise improved cognition after 3 months
compared with one to one conversation with a therapist. Poor studies identified by two systematic reviews provided
insufficient evidence to assess the effects of music therapy in
people with dementia
Clear review with comprehensive description of methodology. Only includes systematic reviews and
RCTs. However, search terms are
unclear. Quality assessment appears to have been undertaken
Table 10b (cont) Music Therapy: Key Characteristics of included systematic reviews (including at least one RCT). General reviews that included Music Therapy
Author,Year
Overall assessment of
the review
Research Question Years covered
Search terms used
Databases searched No of music therapy studies
reviewed
Author’s Conclusions on Music Therapy Study
Comments
Livingston2005
+ A systematic review of psychological approaches to the management of neuropsychiatric
symptoms of dementia with the
aim of making evidence based
recommendations about the use of these
interventions
Electronic database up to July 2003,
Hand searched
three journal during 10
year period up to July
2003
terms encompassing
individual dementias and
interventions – no further details
given
Electronic databases; reference lists from
individual and review articles, Cochrane Library plus hand searched three journals (titles not given)
24 Consistent evidence suggests music therapy decreases
agitation during sessions and immediately after. There is however no evidence that music therapy is useful for
treatment of neuropsychiatric symptoms in the longer term.
Six RCTs ; all showed improvements in disruptive
behaviour
Overall a comprehensive review that is let down by lack of detail in search strategy which means it is not replicable. In addition, due to the very large number of papers
included in the review (162), other than highlighting the RCTs it is
difficult to determine study design or details such as sample characteristics or setting.
Watson 2006
+ Is there evidence for any effective
interventions to assist older people with dementia to feed?
Up to December
2003
feeding, eating,
dementia, mealtimes
CINAHL, Medline, EMBASE and Cochrane
13 The studies are characterised by small sample sizes, there is a lack of RCTs and this type
of intervention is fraught with the problem of confounding
variables.
The quality assessment criteria is not clear. The results section provides a description of the studies but, more critical assessment is provided in the discussion section specifically related to music therapy and assessment of feeding difficulty. The search terms are likely to have limited identification of relevant studies.
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145
Table 10b (cont) Music Therapy: Key Characteristics of included systematic reviews (including at least one RCT). General reviews that included Music Therapy
Author,Year
Overall assessment of
the review
Research Question Years covered
Search terms used
Databases searched No of music therapy studies
reviewed
Author’s Conclusions on Music Therapy Study
Comments
Cohen-Mansfield
2001
- Considers inappropriate behaviours in dementia; a
literature search on the impact of
non-pharmacological interventions (to
address the issues of
understanding of the interventions, their effects and their feasibility)
No dates given
No details given
PsycLIT, MEDLINE, and a nursing subset
of MEDLINE
11 11 studies were identified, all but one reported either significant reduction or positive trend in some
inappropriate behaviours. One reported no effect
The volume of studies included in the overall
review (n=83) mean that some, but not all of the
studies are described, but all are given equal weight. Methodological issues are
presented within the discussion section, these
relate to diverse measurement methods,
criteria for success, screening procedures, control procedures and
treatment of failures. Little or no account is taken of study design (RCT, case
study etc).
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146
Table 11a. Exercise/Physical Activity Reviews: Key Characteristics of included systematic reviews (including at least one RCT).
Author,Year
Overall assessmen
t of the review
Research Question
Years covere
d
Search terms used Databases searched
No of studi
es reviewed
Author’s Conclusions Comments
Eggermont 2006
++ To evaluate the effect of planned physical activity
Lack of strong evidence of statistical significance to prescribe
exercise/physical activity to maintain cognitive function or prevent cognitive decline in
persons with AD.
A weak systematic review. Many of the studies
reported do not reflect the review question (and do not include participants
with AD). It would appear that the
inclusion/exclusion criterion were not
sufficiently focussed.
It is unclear how many studies are included or whether primarily those
with positive results were reported; if this latter
point is true then this may bias the review in favour
of intervention.
The two RCTs reported both have small sample numbers. It is not clear
whether more RCTs were identified.
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148
Table 11b. Exercise/Physical Activity Reviews: Key Characteristics of included systematic reviews (including at least one RCT). General Reviews that included Exercise/Physical Activity
Author,Year
Overall assessm
ent of the
review
Research Question
Years covered
Search terms used
Databases searched No of exercis
e studies review
ed
Author’s Conclusions Comments
Robinson 2006 / 2007 (two papers
on same study)
++ To determine the clinical and
cost effectiveness
and acceptability
of non-pharmacologic
al interventions
to reduce wandering dementia
Search carried out up to and including 31 March
2005
Full details of search terms contained in
appendix
Included Cochrane Library, MEDLINE, EMBASE, Central
CINAHL, Social Science Citation Index, Science
Citation Index, PsycINFO, ADEAR, National Research
Register, ETHX atabase, Bioethicsweb, ISTP, ZETOC,, Journal of
Dementia Care (1999-2004), Dementia (2002-
4), personal contact with specialists in the
field
1 The study produced some evidence that moderate intensity
exercise may reduce wandering. One RCT
that showed significant reduction in wandering
Clear review with comprehensive description of
methodology, literature and findings. The
conclusions are in line with the findings.
Livingston2005
+ A systematic review of
psychological approaches to
the management
of neuropsychiatric symptoms of dementia
with the aim of making
evidence based
recommendations about the use of these interventions
Electronic database up to July 2003,
Hand searched
three journal
during 10 year period up to July
2003
Terms encompassing
individual dementias and interventions –
no further details given
Electronic databases; reference lists from
individual and review articles, Cochrane Library plus hand
searched three journals (titles not given)
4 Graded the level of evidence as troublingly
inconsistent or inconclusive. Two RCTs (a walk-talk programme
and a psychomotor activation programme) found no behavioural
effects
Overall a comprehensive review that is let down by
lack of detail in search strategy which means it is not replicable. In addition,
due to the very large number of papers
included in the review (162), other than
highlighting the RCTs it is difficult to determine
study design or details such as sample
characteristics or setting.
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149
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150
Table 11b (cont). Exercise/Physical Activity Reviews: Key Characteristics of included systematic reviews (including at least one RCT). General Reviews that included Exercise/Physical Activity
Author,Year
Overall assessm
ent of the
review
Research Question
Years covered
Search terms used
Databases searched No of exercis
e studies review
ed
Author’s Conclusions Comments
Cohen-Mansfield
2001
- Considers inappropriate behaviours in dementia; a
literature search on the impact of non-pharmacologic
al interventions
(to address the issues of
understanding of the
interventions, their effects
and their feasibility)
No dates given
No details given PsycLIT, MEDLINE, and a nursing subset of
MEDLINE
4 Outdoor walks (2 studies) ; both found
this intervention led to decreases in
inappropriate behaviour
Physical activities (2 studies); author makes no comment in these studies but the table
shows one study reported decreased
agitation during sensorimotor vs. the
traditional programme, the other reported non
significant trend of decrease in agitation
The volume of studies included in the overall
review) mean that some, but not all of the studies are described, but all are
given equal weight. Methodological issues are
presented within the discussion section, these
relate to diverse measurement methods,
criteria for success, screening procedures, control procedures and treatment of failures. Little or no account is taken of study design (RCT, case study etc).
Leeds Institute of Health Sciences July 2008
151
Table 12. Reality Orientation Interventions: Key Characteristics of included systematic reviews (including at least one RCT). General Reviews that included Reality Orientation
Author,Year
Overall assessmen
t of the review
Research Question Years covered Search terms used
Databases searched No of studies
reviewed
Author’s Conclusions Comments
Livingston
2005
+ A systematic review of psychological
approaches to the management of neuropsychiatric
symptoms of dementia with the aim of making
evidence based recommendations about
the use of these interventions
Electronic database up to
July 2003, Hand searched three journal
during 10 year period up to July 2003
terms encompassing
individual dementias and interventions –
no further details given
Electronic databases; reference lists from
individual and review articles, Cochrane Library plus hand
searched three journals (titles not
given)
11 Inconclusive evidence. 2 RCTs, one showed no immediate benefit
compared with active ward orientation; the other showed a
non-significant improvement when reminiscence therapy was
preceded by reality orientation but not vice versa
Overall a comprehensive review that is let down by lack of detail in search
strategy which means it is not replicable. In addition, due to the very large number of papers included in the review (162), other than highlighting the RCTs it is difficult to determine
study design or details such as sample characteristics or setting.
Bates 2004
+ To investigate the effectiveness of psychological
interventions for people with milder dementing
illness
Search carried out between
April and June 2002
Numerous 15 electronic databases, 10 grey literature sources – details contained in
study appendix
2 Taking the two studies together there is evidence that reality
orientation is an effective intervention in improving
cognitive ability. Neither study demonstrated that reality orientation is effective in improving well-being or
improving communication, functional performance and
cognitive ability.
Overall although most studies were excluded on grounds of quality, the
four retained had low sample size and no power calculations which could
overstate positive results
Verkaik 2005
+ The effect of psychosocial methods
on depressed, aggressive and apathetic
behaviours of people with dementia
Search carried out from
September 2002 to
February 2003
Numerous terms included and
listed
Pubmed, Cochrane CENTRAL/CCTR, Cochrane Database
of Systematic Reviews,
PsychINFO, EMBASE, CINAHL,
INVERT, NIVEL, Cochrane Specialized
Register, CDCIG, SIGLE, DARE.
5 The quality of the five studies was assessed to be low. Only one study found significant improvement in depression; a further study reported improvement in apathy. There are no or
insufficient indications that the intervention reduces depressive, aggressive or apathetic behaviours in people with dementia.
Overall a comprehensive review; however, there is no discussion of the
strength of evidence for no effect / negative effect - only positive effect
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152
Table 13a. Reminiscence Therapy: Key Characteristics of included systematic reviews (including at least one RCT). General Reviews that included Reminiscence Therapy
Author,Year
Overall assessmen
t of the review
Research Question Years covered Search terms used
Databases searched No of studies
reviewed
Author’s Conclusions Comments
Warner 2006
++ What are the effects on cognitive symptoms of
dementia?What are the effects of
treatments on behavioural and psychological
symptoms of dementia?
Up to and including
February 2006
Full details of search strategy
contained on BMJ Clinical
Evidence website
Cochrane Database of Systematic Reviews (on CD-ROM)
1 One systematic review (containing 4 RCTs) found that reminiscence
therapy improved cognition but had no effect on behavioural measures. The included studies used diverse
measures and were often small. Larger and better studies on reminiscence
therapy are needed
Clear review with comprehensive description of
methodology. Only includes systematic reviews and RCTs.
However, search terms are unclear. Quality
assessment appears to have been undertaken within the inclusion
criteria
Woods 2005
++ Assess the effects of reminiscence therapy for older
people with dementia and their
caregivers
Up to and including May
2004
reminiscence Specialised Register contained records from : CENTRAL, MEDLINE, EMBASE, PsycINFO, CINAHL, SIGLE, ISTP, INSIDE, plus Theses and on-going trials. Full details included in paper
5 (data extracted from 4)
The meta-analysis results were statistically significant for cognition (at follow-up), mood (at follow-up), and on a measure of general behavioural function (at end of intervention period). Improvement in cognition was evident in comparison with both no treatment and social contact conditions. However, of the four RCTs included several were very small studies, or were of relatively low quality and each examined different types of reminiscence work. More and better designed trials are needed so more robust conclusions may be drawn.
A clear and concise review. The
conclusions drawn are hampered by the small number and relatively low quality of RCTs, as highlighted by the
Table 13b. Reminiscence Therapy: Key Characteristics of included systematic reviews (including at least one RCT). General Reviews that included Reminiscence Therapy
Author,Year
Overall assessmen
t of the review
Research Question Years covered Search terms used
Databases searched No of studies
reviewed
Author’s Conclusions Comments
Livingston2005
+ A systematic review of psychological
approaches to the management of neuropsychiatric
symptoms of dementia with the aim of making
evidence based recommendations about
the use of these interventions
Electronic database up to
July 2003, Hand searched three journal
during 10 year period up to July 2003
terms encompassing
individual dementias and interventions –
no further details given
Electronic databases; reference lists from individual and review articles,
Cochrane Library plus hand searched three journals (titles not
given)
5 Assigned a grade equivalent to troublingly
inconsistent or inconclusive studies. Of the three RCTs included
one found a non-significant improvement
when reminiscence therapy was preceded by reality orientation but not vice versa; the other found no benefit
Overall a comprehensive review that is let down by lack of detail in search
strategy which means it is not replicable. In addition, due to the very large number of papers included in the review (162), other than highlighting the RCTs it is difficult to determine
study design or details such as sample characteristics or setting.
Verkaik 2005
+ The effect of psychosocial methods
on depressed, aggressive and apathetic
behaviours of people with dementia
Search carried out from
September 2002 to
February 2003
Numerous terms included and
listed
Pubmed, Cochrane CENTRAL/CCTR, Cochrane
Database of Systematic Reviews, PsychINFO, EMBASE, CINAHL,
Overall no evidence for efficacy of snoezelen for dementia. There is a need
for more reliable and sound research-based
evidence to inform and justify the use of snoezelen
in dementia care.
A comprehensive update of a previous review.
Lancioni 2002
- Examining within-session, post-session
and longer-term effects of snoezelen
with people with developmental disabilities and
dementia
No details given
No details PSYCLIT, Medical Express 21 but only 7 relating to dementia
Authors ‘tentative considerations’:
1. Snoezelen may have positive within-session
effects on stereotypes that are self-stimulatory in
nature and on social/emotional
behaviours that are part of a withdrawal condition in
dementia patients.2. Such positive effects could be increased by choosing appropriate stimuli for individual
participants.3. Increasing within-
session positive effects may increase post-session
effects.
Only PSYCLIT and Medical Express databases were included in the computerised search. No details
of keywords used, numbers of papers initially retrieved,
inclusion/exclusion criteria, or process followed.
There is a very limited discussion of study methodologies that is
divorced from the results and does not provide strong guidance on the
interpretation of results from
individual studies. The poor literature search and inclusion of (presumably) low-quality studies without significant discussion of this may result in effects being
Table 14b. Snoezelen Therapy/Multisensory Stimulation: Key Characteristics of included systematic reviews (including at least one RCT). General Reviews that included Snoezelen Therapy/Multisensory Stimulation
Author,Year
Overall assessmen
t of the review
Research Question Years covered Search terms used Databases searched No of snoezelen
/ MSS studies
reviewed
Author’s Conclusions Comments
Robinson 2006 /
2007 (two papers on
same study)
++ To determine the clinical and cost effectiveness and
acceptability of non-pharmacological
interventions to reduce wandering dementia
Search carried out up to and including 31 March 2005
Full details of search terms contained in
appendix
Included Cochrane Library, MEDLINE, EMBASE,
Central CINAHL, Social Science Citation Index, Science Citation Index,
PsycINFO, ADEAR, National Research Register, ETHX
atabase, Bioethicsweb, ISTP, ZETOC,, Journal of Dementia Care (1999-2004), Dementia (2002-4), personal contact with specialists in the field
3 Some evidence, albeit of poor quality, for the
effectiveness of multi-sensory environment. Three RCTs; two did not provide evidence that a multisensory
environment effectively prevents wandering; the third provide no follow
up details and so the study yielded no
information about effectiveness.
Clear review with comprehensive description of methodology, literature and findings. The conclusions are in
line with the findings.
Livingston2005
+ A systematic review of psychological
approaches to the management of neuropsychiatric
symptoms of dementia with the aim of making
evidence based recommendations about
the use of these interventions
Electronic database up to
July 2003, Hand searched three journal
during 10 year period up to July 2003
terms encompassing individual dementias and interventions – no further details
given
Electronic databases; reference lists from individual and review articles, Cochrane
Library plus hand searched three journals (titles not given)
6 Consistent evidence from non-RCTs; the
effects are apparent for only very short time
after the session. Three RCTs; one with no clear
results; two found disruptive behaviour
briefly improved outside the treatment setting but there was no effect after
the treatment stopped
Overall a comprehensive review that is let down by lack of detail in search
strategy which means it is not replicable. In addition, due to the very large number of papers included in the review (162), other than highlighting the RCTs it is difficult to determine
study design or details such as sample characteristics or setting.
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156
Table 14b (cont). Snoezelen Therapy/Multisensory Stimulation: Key Characteristics of included systematic reviews (including at least one RCT). General Reviews that included Snoezelen Therapy/Multisensory Stimulation
Author,Year
Overall assessmen
t of the review
Research Question Years covered Search terms used Databases searched No of snoezelen / multi-sensory studies
reviewed
Author’s Conclusions Comments
Verkaik 2005
+ The effect of psychosocial methods
on depressed, aggressive and apathetic
behaviours of people with dementia
Search carried out from
September 2002 to
February 2003
Numerous terms included and listed
Pubmed, Cochrane CENTRAL/CCTR, Cochrane
Database of Systematic Reviews, PsychINFO, EMBASE, CINAHL,
Specialised Register contained records from : CENTRAL, MEDLINE, EMBASE, PsycINFO, CINAHL, SIGLE, ISTP, INSIDE, plus Theses and on-going trials. Full details included in paper
9 (of which 3 included in meta
analysis)
TENS produced a statistically significant improvement directly after treatment in delayed recall in one trial, face recognition in two trials and motivation in one trial. No effect on the other neuropsychological and behaviour measures either directly after or 6 weeks after treatment/ Authors conclude: TENS may produce in some neuropsychological or behavioural aspects of dementia. The limited presentation and availability of data from these studies does not allow definite conclusions on possible benefits. Re safety: although unlikely to have adverse effects,
A comprehensive and well designed review. The review
suggests the potential benefits of TENS for people with dementia. The studies included demonstrated
consistency in experimental designs, subjects,
interventions and outcome measures but unfortunately
only three could be used in the meta-analysis. As suggested
by the authors to increase the generalisability of the findings to a wider population the work be replicated in a larger group
of individuals.
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158
insufficient data to
recommend use.
Leeds Institute of Health Sciences July 2008
159
Table 16a. Validation Therapy: Key Characteristics of included systematic reviews (including at least one RCT).
Author,Year
Overall assessmen
t of the review
Research Question Years covered Search terms used Databases searched No of exercise studies
reviewed
Author’s Conclusions Comments
Neal 2003 ++ What is the efficacy of validation therapy, offered in group or
individual format, as an intervention for patients
with dementia or cognitive impairment?
Search carried out August
2005. No date exclusion
Validation therapy, VDT, emotion oriented care
Specialised Register contained records from : CENTRAL,
MEDLINE, EMBASE, PsycINFO, CINAHL, SIGLE, ISTP, INSIDE, Aslib Index to theses, Dissertation Abstract
(USA), http://clinicalstudies.info.nih.g
ov/, National Research Register, ClinicalTrails.gov,
Table 16b. Validation Therapy: Key Characteristics of included systematic reviews (including at least one RCT). General Reviews that included Validation Therapy
Author,Year
Overall assessmen
t of the review
Research Question Years covered Search terms used Databases searched No of exercise studies
reviewed
Author’s Conclusions Comments
Livingston2005
+ A systematic review of psychological
approaches to the management of neuropsychiatric
symptoms of dementia with the aim of making
evidence based recommendations about
the use of these interventions
Electronic database up to
July 2003, Hand searched three journal
during 10 year period up to July 2003
terms encompassing individual dementias and interventions – no further details
given
Electronic databases; reference lists from individual and review articles, Cochrane
Library plus hand searched three journals (titles not given)
3 No conclusive evidence. Only one RCT
comparing validation therapy to usual care or a social contact group.
No difference was found in independent
outcome ratings, nursing time needed or in use of psychotropic
medication and restraint
Overall a comprehensive review that is let down by lack of detail in search
strategy which means it is not replicable. In addition, due to the very large number of papers included in the review (162), other than highlighting the RCTs it is difficult to determine
study design or details such as sample characteristics or setting.
Verkaik 2005
+ The effect of psychosocial methods
on depressed, aggressive and apathetic
behaviours of people with dementia
Search carried out from
September 2002 to
February 2003
Numerous terms included and listed
Pubmed, Cochrane CENTRAL/CCTR, Cochrane
Database of Systematic Reviews, PsychINFO, EMBASE, CINAHL,
3 studies found no significant changes in apathy, aggression or depression. The fourth found a significant change in depression after 1 year compared with alternate therapy but not usual care group.
Overall a comprehensive review; however, there is no discussion of the
strength of evidence for no effect / negative effect - only positive effect
Table 17. Characteristics of included systematic reviews that did not identify any studies for inclusion
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Author,Year
Overall assessment of
the review
Research Question
Years covered
Search terms used
Databases searched No of studies
reviewed
Author’s Conclusions
Comments
Herman 2007
++ Evaluating the effectiveness and safety of non-pharma
interventions in reducing
wandering in domestic settings
Search conducted May 2006. No explicit
date exclusion
Exit*, wander* or elopement or ambulat* or
walk*
Specialised Register contained records from : CENTRAL, MEDLINE, EMBASE, PsycINFO, CINAHL, SIGLE, ISTP, INSIDE, Aslib Index to theses,
Dissertation Abstract (USA), LILACS,
http://clinicalstudies.info.nih.gov/, National Research Register,
Alzheimers Society (UK)Alzheimer’s Association (USA)Alzheimer’s AustraliaAlzheimer* EuropeReview (from section two)*
*The website states that anxiety, fear, agitation, nervousness, anger and frustration can all lead to aggressive behaviour and refers the reader to those pages for useful tips
in addition to those identified above (http://www.alzheimer-europe.org/index.php?lm3=6761D7E11104&sh=6C43BEDD7AAD)
Matrix 2b. Agitation or Anxiety Strategy
Organsiation
Activities to relieve boredom / distract
AAT Aromatherapy / massage or touch
Behaviour management
Cognitive stimulation
Counselling Environmental manipulation
Light therapy
Music / music therapy
Physical exercise / activity
Reality orientation
Reminiscence / reminscence therapy
MSS TENS Validation / validation therapy
Alzheimers Society (UK)Alzheimer’s Association (USA)Alzheimer’s AustraliaAlzheimer* EuropeReview (from section two)*
Alzheimers Society (UK)Alzheimer’s Association (USA)Alzheimer’s AustraliaAlzheimer* EuropeReview (from section two)*
Matrix 2d. Hallucinations Strategy
Organsiation
Activities to relieve boredom / distract
AAT Aromatherapy / massage or touch
Behaviour management
Cognitive stimulation
Counselling Environmental manipulation
Light therapy
Music / music therapy
Physical exercise / activity
Reality orientation
Reminiscence / reminscence therapy
MSS TENS Validation / validation therapy
Alzheimers Society (UK)Alzheimer’s Association (USA)Alzheimer’s AustraliaAlzheimer EuropeReview (from section two)*
*Hallucinations not referred to specifically
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Matrix 2e. Sleeplessness Strategy
Organsiation
Activities to relieve boredom / distract
AAT Aromatherapy / massage or touch
Behaviour management
Cognitive stimulation
Counselling Environmental manipulation
Light therapy
Music / music therapy
Physical exercise / activity
Reality orientation
Reminiscence therapy
MSS TENS Validation / validation therapy
Alzheimers Society (UK)Alzheimer’s Association (USA)Alzheimer’s AustraliaAlzheimer EuropeReview (from section two)
Matrix 2f. Wandering Strategy
Organsiation
Activities to relieve boredom / distract
AAT Aromatherapy / massage or touch
Behaviour management
Cognitive stimulation
Counselling Environmental manipulation
Light therapy
Music / music therapy
Physical exercise / activity
Reality orientation
Reminiscence therapy
MSS TENS Validation / validation therapy
Alzheimers Society (UK)Alzheimer’s Association (USA)Alzheimer’s AustraliaAlzheimer EuropeReview (from section two)
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REFERENCES
References (studies/papers included in review)
Bates J, Boote J, Beverley C. Psychosocial interventions for people with a milder dementing illness: a systematic review. J Adv Nurs. 2004 Mar;45(6):644-58.
Cameron M, Longeran E, Lee H. Transcutaneous Electrical Nerve Stimulation (TENS) for Dementia. Cochrane Database Syst Rev. 2003(3).
Chung JCC, Lai CKY. Snoezelen for dementia. Cochrane Database Syst Rev. 2002(4).
Clare L, Woods RT. Cognitive rehabilitation and cognitive training for early-stage Alzheimer's disease and vascular dementia. Cochrane Database Syst Rev. 2003(4).
Cohen-Mansfield J. Nonpharmacologic interventions for inappropriate behaviors in dementia: a review, summary, and critique. Am J Geriatr Psychiatry. 2001;9(4):361-81.
Diamond B, Johnson S, Torsney K, Morodan J, Prokop B, Davidek D, et al. Complementary and alternative medicines in the treatment of dementia: an evidence-based review. Drugs Aging. 2003;20(13):981-98.
Eggermont LH, Scherder EJ. Physical activity and behaviour in dementia: A review of the literature and implications for psychosocial intervention in primary care. Dementia: The International Journal of Social Research and Practice. 2006 Aug;5(3):411-28.
Filan SL, Llewellyn-Jones RH. Animal-assisted therapy for dementia: A review of the literature. Int Psychogeriatr. 2006;18(4):597-611.
Forbes D, Morgan DG, Bangma J, Peacock S, Adamson J. Light Therapy for Managing Sleep, Behaviour, and Mood Disturbances in Dementia. Cochrane Database Syst Rev. 2004(2).
Grandmaison E, Simard M. A critical review of memory stimulation programs in Alzheimer's disease. J Neuropsychiatry Clin Neurosci. 2003;15(2):130-44.
Hermans DG, Htay UH, McShane R. Non-pharmacological interventions for wandering of people with dementia in the domestic setting. Cochrane Database Syst Rev. 2007(1):CD005994.
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166
Kim S, Song HH, Yoo SJ. The effect of bright light on sleep and behavior in dementia: an analytic review. Geriatr Nurs. 2003;24(4):239-43.
Lancioni GE, Cuvo AJ, O'Reilly MF. Snoezelen: an overview of research with people with developmental disabilities and dementia. Disabil Rehabil. 2002;24(4):175-84.
Livingston G, Johnston K, Katona C, Paton J, Lyketsos CG. Systematic review of psychological approaches to the management of neuropsychiatric symptoms of dementia. Am J Psychiatry. 2005 Nov;162(11):1996-2021.
Lou M. The use of music to decrease agitated behaviour of the demented elderly: the state of the science. Scand J Caring Sci. 2001;15(2):165-73.
Neal M, Barton Wright P. Validation therapy for dementia. Cochrane Database Syst Rev. 2003(3).
Nugent N. Agitated behaviours in Alzheimer's Disease and related disorders: Music and music therapy research. Australian Journal of Music Therapy Vol 13 2002, 38-50. 2002.
Peng WN, Zhao H, Liu ZS, Wang S. Acupuncture for vascular dementia. Cochrane Database Syst Rev. 2007(2):CD004987.
Penrose FK. Can exercise affect cognitive functioning in Alzheimer's disease? A review of the literature. Activities Adapt Aging. 2005;29(4):15-40.
Price JD, Hermans DG, Grimley Evans J. Subjective barriers to prevent wandering of cognitively impaired people. Cochrane Database Syst Rev. Chichester, UK: John Wiley & Sons, Ltd 2001.
Robinson L, Hutchings D, Corner L, Beyer F, Dickinson H, Vanoli A, et al. A systematic literature review of the effectiveness of non-pharmacological interventions to prevent wandering in dementia and evaluation of the ethical implications and acceptability of their use. Health Technology Assessment. 2006 Aug;10(26):iii, ix-108.
Robinson L, Hutchings D, Dickinson HO, Corner L, Beyer F, Finch T, et al. Effectiveness and acceptability of non-pharmacological interventions to reduce wandering in dementia: a systematic review. Int J Geriatr Psychiatry. 2007 Jan;22(1):9-22.
Sherratt K, Thornton A, Hatton C. Music interventions for people with dementia: a review of the literature. Aging Ment Health. 2004 Jan
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Jan;8(1):3-12.
Sitzer DI, Twamley EW, Jeste DV. Cognitive training in Alzheimer’s disease: a meta analysis of the literature. ACTA Psychiatrica Scandinavica. 2006; 114: 75-90
Skjerve A, Bjorvatn B, Holsten F. Light therapy for behavioural and psychological symptoms of dementia. Int J Geriatr Psychiatry. 2004 Jun;19(6):516-22.
Spira AP, Edelstein BA. Behavioral interventions for agitation in older adults with dementia: an evaluative review. Int Psychogeriatr. 2006 JunJun;18(2):195-225.
Sung HC, Chang AM. Use of preferred music to decrease agitated behaviours in older people with dementia: a review of the literature. J Clin Nurs. 2005 Oct;14(9):1133-40.
Thorgrimsen L, Spector A, Orrell M. The use of aromatherapy in dementia care: A review. Journal of Dementia Care. 2006;14(2):33-6.
Thorgrimsen L, Spector A, Wiles A, Orrell M. Aroma therapy for dementia. Cochrane Database Syst Rev. 2003(3):CD003150.
Verkaik R, van Weert JCM, Francke AL. The effects of psychosocial methods on depressed, aggressive and apathetic behaviors of people with dementia: a systematic review. Int J Geriatr Psychiatry. 2005 Apr;20(4):301-14.
Viggo Hansen N, Jorgensen T, Ortenblad L. Massage and touch for dementia. Cochrane Database Syst Rev. 2006(4).
Vink AC, Birks JS, Bruinsma MS, Scholten RJP. Music therapy for people with dementia. Cochrane Database Syst Rev. 2003(4).
Warner J, Butler R, Wuntakal B. Dementia. Clin Evid 2006:1361-90.
Watson R, Green SM. Feeding and dementia: a systematic literature
review. Journal of Advanced Nursing. 2006; 54(1); 86-93
Woods B, Spector A, Jones C, Orrell M, Davies S. Reminiscence
therapy for dementia. Cochrane Database Syst Rev. 2007(4).
Dementia Organisation (websites included in Section Three)
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Alzheimer’s Society http://www.alzheimers.org.uk/site/
Alzheimer Australia http://www.alzheimers.org.au/
Alzheimer Association http://www.alz.org/index.asp
Alzheimer Europe http://www.alzheimer-europe.org/
References (report references)
Baker, R., Bell, S., Assey, J., et al. 1998. A Randomised Controlled
Trial of the Snoezelen Mulit-sensory Environment for Patients with
13. ("review" or "review academic" or "review literature").pt.
14. 12 or 13
15. 11 and 14
16. limit 15 to yr="2001 - 2007"
2. OVID CINAHL 1982 – Nov 2007
1. exp Occupational Therapy/
2. Recreational Therapy/
3. exp *Rehabilitation/
4. exp Sensory Stimulation/
5. ((occupation$ or recreation$) adj2 (therap$ or intervention$)).tw.
6. ((art$ or music$ or danc$ or drama$ or craft$ or game$) adj2 (therap$ or intervent$)).tw.
7. ((book$ or exercis$ or work$ or vocational$ or swim$ or light$) adj2 (therap$ or intervent$)).tw.
8. bibliotherap$.tw.
9. snoezelen$.tw.
10. ((sound$ or noise$ or acoustic$) adj2 (stimulat$ or therap$)).tw.
11. dolls.tw.
12. or/1-11
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13. exp *psychotherapy/
14. (reality$ adj2 orient$).tw.
15. (reminisc$ adj2 (therap$ or intervent$ or treat$)).tw.
16. reminisce.tw.
17. ((validation$ or cognitiv$ or behavio$) adj2 (therap$ or intervent$ or treatment$)).tw.
18. or/13-17
19. exp *Alternative Therapies/
20. (acupunctur$ or aromatherap$ or homeopath$ or hypnosis$ or reflexolog$ or witchcraft$ or meditat$).tw.
21. ((magic$ or laugh$ or comedy$ or rejuvenat$) adj2 (therap$ or intervent$)).tw.
22. or/19-21
23. 12 or 18 or 22
24. exp *Dementia/
25. exp delirium/
26. Wernicke's Encephalopathy/
27. systematic review.pt.
28. (systemat$ adj3 review$).ti.
29. 27 or 28
30. or/24-26
31. 23 and 29 and 30
32. limit 31 to yr="2001 - 2007"
3. OVID EMBASE 1996 – Nov 2007
1. occupational therapy/
2. bibliotherap$.tw.
3. exp recreation/
4. ((occupation$ or recreation$) adj2 (therap$ or intervention$)).tw.
5. exp kinesiotherapy/
6. vocational rehabilitation/
7. Recreational Therapy/
8. exp sensory stimulation/ or auditory stimulation/
9. exp psychotherapy/
10. ((art$ or music$ or danc$ or drama$ or craft$ or game$) adj2 (therap$ or intervent$)).tw.
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11. ((book$ or exercis$ or work$ or vocational$ or swim$ or light$) adj2 (therap$ or intervent$)).tw.
12. (reality$ adj2 orient$).tw.
13. (reminisc$ adj2 (therap$ or intervent$ or treat$)).tw.
14. reminisce.tw.
15. ((validation$ or cognitiv$ or behavio$) adj2 (therap$ or intervent$ or treatment$)).tw.
16. exp alternative medicine/
17. exp acupuncture/ or exp acupressure/
18. religion/
19. homeopathy/
20. hypnosis/
21. exp Manipulative Medicine/
22. exp traditional medicine/
23. ginkgo biloba/
24. (acupunctur$ or aromatherap$ or homeopath$ or hypnosis$ or reflexolog$ or witchcraft$).tw.
25. meditat$.tw.
26. ((magic$ or laugh$ or comedy$ or rejuvenat$) adj2 (therap$ or intervent$)).tw.
27. snoezelen$.tw.
28. ((faith$ or spiritual$) adj2 (healing$ or healer$)).tw.
29. exp *Dementia/
30. exp *Delirium/
31. exp *Prion Disease/
32. *korsakoff psychosis/ or *wernicke encephalopathy/ or *wernicke korsakoff syndrome/
33. or/29-32
34. exp review/
35. (systematic$ adj3 review$).ti.
36. 34 or 35
37. or/1-28
38. 37 and 33 and 36
39. limit 38 to yr="2001 - 2008"
4. OVID MEDLINE 1996 – Nov 2007
1. exp psychotherapy/
2. (reality adj2 orientat$).tw.
3. reality-orient$.tw.
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4. validation therapy.tw.
5. reminisce.tw.
6. reminiscence.tw.
7. (cogniti$ adj2 therap$).tw.
8. (behavio$ adj2 therap$).tw.
9. (psychosocial$ adj2 (help or therap$ or intervention$ or strateg$ or treat$)).tw.
10. or/1-9
11. exp Occupational Therapy/
12. exp bibliotherapy/
13. exp exercise therapy/
14. exp rehabilitation, vocational/
15. exp Recreation/
16. exp Sensory Art Therapies/
17. (recreation$ adj5 therapy).mp.
18. recreation.tw.
19. multi-sensory.tw.
20. (art adj5 therapy).tw.
21. (danc$ adj5 therapy).tw.
22. (swim$ adj5 therapy).tw.
23. dolls.tw.
24. snoezelen$.tw.
25. (music$ adj5 therapy).tw.
26. game.tw.
27. games.tw.
28. gaming.tw.
29. (craft$ adj5 therapy).tw.
30. (work adj2 therapy).tw.
31. (vocational adj2 therapy).tw.
32. exp Reality Therapy/
33. or/11-32
34. exp Complementary Therapies/
35. aromatherapy$.tw.
36. acupunctur$.tw.
37. (sensory$ adj2 integrat$).tw.
38. reflexology$.tw.
39. herbal$.tw.
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40. ginkgo$.tw.
41. ginseng$.tw.
42. exp Phototherapy/
43. (light$ adj therap$).tw.
44. ((acoustic$ or noise$ or sound$) adj (therap$ or stimulat$)).tw.
45. or/34-44
46. 10 or 33 or 45
47. exp *Dementia/
48. exp *Delirium/
49. exp *wernicke encephalopathy/
50. exp *korsakoff syndrome/
51. "benign senescent".tw.
52. or/47-51
53. 46 and 52
54. "review [publication type]"/
55. (systematic$ adj3 review$).ti.
56. 54 or 55
57. 53 and 56
58. limit 57 to yr="2001 - 2007"
5. OVID PSYCHINFO 2000 – Nov 2007
1. exp Occupational Therapy/
2. exp *creative arts therapy/
3. exp *exercise/
4. exp *games/
5. exp *psychodrama/
6. exp *phototherapy/
7. exp *vocational rehabilitation/
8. bibliotherap$.tw.
9. ((art$ or music$ or danc$ or drama$ or craft$ or game$) adj2 (therap$ or intervent$)).tw.
10. ((book$ or exercis$ or work$ or vocational$ or swim$ or light$) adj2 (therap$ or intervent$)).tw.
11. snoezelen$.tw.
12. dolls.tw.
13. or/1-12
14. exp *psychotherapy/
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15. *reminiscence/
16. (reality$ adj2 orient$).tw.
17. (reminisc$ adj2 (therap$ or intervent$ or treat$)).tw.
18. reminisce.tw.
19. ((validation$ or cognitiv$ or behavio$) adj2 (therap$ or intervent$ or treatment$)).tw.
20. or/14-19
21. exp *alternative medicine/
22. *massage/
23. exp *hypnosis/ or exp *hypnotherapy/
24. *biofeedback training/ or *holistic health/ or hypnotherapy/ or *meditation/ or *phototherapy/
25. *dietary supplements/ or *"medicinal herbs and plants"/ or *osteopathic medicine/
26. exp *religious practices/
27. exp *relaxation therapy/
28. exp *witchcraft/
29. (acupunctur$ or aromatherap$ or homeopath$ or hypnosis$ or reflexolog$ or witchcraft$).tw.
30. ((magic$ or laugh$ or comedy$ or rejuvenat$) adj2 (therap$ or intervent$)).tw.
31. meditat$.tw.
32. or/21-31
33. 13 or 20 or 32
34. exp *dementia/
35. exp *delirium/
36. exp *huntingtons disease/
37. exp *korsakoffs psychosis/ or exp *wernickes syndrome/
38. or/34-37
39. 33 and 38
40. review$.ti. or review$.ab.
41. 39 and 40
6. WILEY COCHRANE LIBRARY REVIEWS 2007 Issue 4: [HM-DEMENTIA, from 2001 to 2007 in all products] and limited to published reviews
7. Wiley Cochrane Library Database of Abstracts of Reviews of Effects 2007 Issue 4:
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[(dement* OR deliriu* OR alzheimer* OR creutzfeld* OR korsakoff*) in Title, Abstract or Keywords, from 2001 to 2007 in all products]
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APPENDIX TWO (data extraction template)
Methodology checklistA.1 Methodology checklist: systematic reviews and meta-analysesStudy identification
Include author, title, reference, year of publicationGuideline topic Key question no:Checklist completed by:SECTION 1: INTERNAL VALIDITYIn a well-conducted systematic review: In this study this criterion is:
(Circle one option for each question)
1.1 The study addresses an appropriate and clearly focused question.
Well covered Not addressedAdequately addressed Not reportedPoorly addressed Not applicable
1.2 A description of the methodology used is included.
Well covered Not addressedAdequately addressed Not reportedPoorly addressed Not applicable
1.3 The literature search is sufficiently rigorous to identify all the relevant studies.
Well covered Not addressedAdequately addressed Not reportedPoorly addressed Not applicable
1.4 Study quality is assessed and taken into account.
Well covered Not addressedAdequately addressed Not reportedPoorly addressed Not applicable
1.5 There are enough similarities between the studies selected to make combining them reasonable.
Well covered Not addressedAdequately addressed Not reportedPoorly addressed Not applicable
SECTION 2: OVERALL ASESSMENT OF THE STUDY2.1 How well was the study done to
minimise bias? Code ++, + or -2.2 If coded as + or – what is the likely
direction in which bias might affect the study results?
SECTION 3: DESCRIPTION OF THE STUDY Please print answers clearly3.1 What types of study are
included in the review? (Highlight all that apply)
RCT CCT Cohort
Case-control Other3.2 How does this review help to
answer your key question?Summarise the main conclusion of the review and how it related to the relevant key question. Comment on any particular strengths or weaknesses of the review