Aromatherapy and reminiscence therapy (RT) were the most effective psychosocial interventions for improving quality of life (QoL) in patients with moderate to severe dementia, according to results of a systemic review published in the International Journal of Geriatric Psychiatry.

Currently, there are 50 million people worldwide with dementia and treatment options are limited for its moderate to severe forms. Available treatments are tailored to decrease symptoms rather than improve cognition and QoL. In this systematic review, researchers aimed to measure the efficacy of currently available psychosocial interventions to determine whether they improve cognition and QoL in patients with moderate to severe dementia.

Between January and April  2020, researchers conducted a systemic review (PROSPERO: CRD42020167483) using information obtained from 6 databases to identify randomized controlled trials (RCT) that measured the effects of psychosocial interventions on cognitive function and QoL in patients with dementia. A total of 14 RCTs conducted between 2000 and 2020 were included in the final analysis.


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The RCTs included adult patients (N=1161) with a specified stage of dementia. If the stage of dementia was not specified, then a mean Mini‐Mental State Examination score  of 20 or less, a Clinical Dementia Rating score of at least 2, or a Global Deterioration Scale score of at least 5 were used to determine whether patients met the criteria for inclusion in the review.

The researchers assessed the studies’ methodologies using the Physiotherapy Evidence Database (PEDro) Scale and the Consolidated Standards of Reporting Trials guidelines.

The 14 RCTs included were conducted in Europe, South America, and Asia. Of the studies, the mean PEDro score was 5.86 on a 10-point scale, 10 had a low risk of bias, 8 were single-blinded, 8 were sufficiently powered, and 5 included a confidence interval.

Among the psychosocial interventions included in the RCTs, 6 used multisensory stimulation (MSS) interventions, 5 used multicomponent programs, 2 used exercise programs, and 1 used RT.

Of the MSS interventions, which included Snoezelen rooms, robotic pets, music therapy, and aromatherapy, only aromatherapy significantly improved QoL (P =.01; PEDro, 7).

The RCT that used RT, which was sufficiently powered (n=135) and had high quality ratings, indicated that the intervention enhanced QoL (P <.01).

In 1 of the 2 RCTs that used an exercise program intervention, which was sufficiently powered and had a PEDro score of 6, results showed that cycling for 15 minutes daily for 15 months significantly improved cognition.

In 1 of 5 RCTs that used a multicomponent intervention, results showed that a combination of aerobic exercise, memory games, and music therapy significantly improved cognitive function; however, the study had a small sample size and the quality was low (PEDro, 5; n=36). In addition, results of RCT that used a multicomponent intervention of movement and music, which was sufficiently powered and had a PEDro score of 6, showed a positive trend in cognitive improvement (P =.055).

The researchers noted that reminiscence therapy and MSS with robotic pets were linked to increased social engagement and increased positive emotions, respectively. They also found that patients’ mobility increased in studies which used aerobic exercise interventions.

Study limitations included the small number of studies per intervention type, variation in assessments of QoL, and the exclusion of studies that used cognitive stimulation therapy due to the inability to separate the results of patients with moderate dementia from those with mild dementia.

“Various types of current psychosocial interventions can enhance the health of people with moderate to severe dementia. However, future research with well‐defined and quality outcome measures with a rigorous study design is required before recommendations can be made regarding the use and prescription of MSS, RT , exercise, or multicomponent interventions for people with moderate to severe dementia,” the researchers concluded.

Reference

Hui EK, Tischler V, Wong GHY, et al. Systematic review of the current psychosocial interventions for people with moderate to severe dementia. Int J Geriatr Psychiatry. Published online: August 4, 2021. doi: 10.1002/gps.5554