Managing neuropsychiatric symptoms and challenging behaviours in patients with dementia often involves the use of antipsychotic drugs. However, the use of these drugs pose considerable risk to patients, and current guidance is to use non-pharmacological interventions for treating these behavioural problems. However, the scientific evidence on the effectiveness of alternatives to antipsychotic drug prescribing has not been collected or assessed systematically. PIRU examined 30 recent systematic reviews in order to provide a comprehensive overview of the effectiveness of non-pharmacological interventions, in order to provide policy-makers, commissioners and clinicians with the best current evidence available.
The project was carried out in collabortion with Louise Lafortune, CLAHRC CP and University of Cambridge, and Kelly Dickson, Josephine Kavanagh, and James Thomas from the EPPI-Centre, Institute of Education.
In all, 19 non-pharmacological treatments were identified in the systematic reviews. The most consistent evidence for managing behavioural and psychological symptoms was found for behaviour management techniques delivered by professional staff, and for staff and caregiver training and support. There was also promising evidence for four other interventions: physical activity/exercise; massage/touch therapies; multi-sensory stimulation; and music therapy. For the majority of alternatives, however, the evidence was inconclusive, either because it was inconsistent across studies, or the primary studies were of poor quality, or there was a lack of evidence.
The overview of systematic reviews was provided to the Department of Health in March 2012 and the results have been presented at a number of conferences.
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