Nonpharmacologic Interventions for Alzheimer’s Have Greater Impact on Outcomes Than Currently Available Medications

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Funding needs to be more widely available to help implement these effective nonpharmacologic interventions.
The following article is part of conference coverage from the 2018 Alzheimer’s Association International Conference in Chicago, Illinois. Neurology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from AAIC 2018.

CHICAGO – There is substantial evidence supporting the use of nonpharmacologic interventions, specifically multi-domain interventions, for improvement of outcomes in patients with Alzheimer disease and related disorders. Results of the evidence review were presented at the 2018 Alzheimer’s Association International Conference, July 22-26, 2018 in Chicago, Illinois.

Investigators led by Deborah E. Barnes, PhD, MPH, of the University of California, San Francisco identified systematic reviews and meta-analyses of pharmacologic and nonpharmacologic interventions in people with Alzheimer disease and related disorders that evaluated outcomes including physical function, cognitive function, quality of life, dementia-related behaviors, and caregiver well-being. They identified 139 randomized controlled trials (n=10,373) evaluating nonpharmacologic interventions and 34 randomized controlled trials (n=14,392) evaluating pharmacologic interventions.

The investigators found that standardized effect size for dementia medications were consistent with improvements in physical function (0.11-0.29) and cognitive function (0.28-0.33) in all trials, and dementia-related behaviors (0.22) in the trial evaluating memantine, only. However, no benefit for quality of life or caregiver well-being was noted.

Alternately, effect sizes for nonpharmacologic interventions signify improvements in targeted domains, including: physical function (0.68), cognitive function (0.41), quality of life (0.44), anxiety (0.64), dementia-related behaviors (0.49), and caregiver well-being (0.27). Notably, cognitive training was not associated with improvement in any outcomes, while multidomain interventions were associated with improvements across all outcomes (0.31-0.68).

Ultimately, the results of the review showed that nonpharmacologic interventions are capable of improving various clinically meaningful outcomes in this population “with standardized effect sizes that are 2 to 3 times larger than currently available dementia medications,” the investigators reported. They recommend that funding needs to be more widely available to help implement these effective nonpharmacologic interventions.

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Williams S, Hotchkiss L, Matouk N, Haseeb M, Barnes DE. Comparison of pharmacologic and non-pharmacologic interventions in people with Alzheimer’s disease and related disorders. Presented at: 2018 Alzheimer’s Association International Conference. July 22-26, 2018; Chicago, IL. Poster 1.654.