Comparative efficacy of non-pharmacological interventions on behavioural and psychological symptoms in elders with dementia: A network meta-analysis.
Wenjie Li, Xiaofeng Xu, Fen Wu and 3 others
PMID 34472717WHAT IT FOUND
Reminiscence therapy reduced neuropsychiatric symptoms compared with no specific non-pharmacological care.
Individualized nursing reduced depression and anxiety and raised cognitive test scores, but many comparisons were not head-to-head and study quality was uncertain.
Key findings
01Reminiscence therapy significantly reduced Neuropsychiatric Inventory scores compared with no specific non-pharmacological intervention (mean difference -10.42).
02Individualized nursing significantly reduced depression scores compared with no specific non-pharmacological intervention (mean difference -6.24), significantly reduced anxiety scores compared with no specific non-pharmacological intervention (mean difference -4.77), and significantly raised Mini-Mental State Examination scores compared with no specific non-pharmacological intervention (mean difference 3.43).
03Behaviour therapy significantly reduced depression scores compared with no specific non-pharmacological intervention (mean difference -5.87) and significantly reduced anxiety scores compared with no specific non-pharmacological intervention (mean difference -7.56).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The review included only indirect comparisons with no specific non-pharmacological intervention, not direct head-to-head comparisons, so it cannot reliably tell which intervention is best for a patient. Many included studies were small, and most had uncertain risk of bias, so the estimates may be imprecise. The analysis did not include all interventions listed in the eligibility criteria, and some outcomes could not be assessed for publication bias. The results text and the table/ranking disagree about which intervention improved daily function, so that finding is unclear. The studies were short-term and single-cycle, so longer-term effects are not shown. Individualized nursing is a package of nursing activities, so the review cannot identify which component produced the effects.
Declared interests
The authors declare that they have no competing interests.
The easy way to misread this
Do not read this as proof that any one non-pharmacological intervention is the best treatment for all behavioural and psychological symptoms of dementia. Most comparisons were indirect versus no specific non-pharmacological intervention, many were not significant, and individualized nursing is a package of activities, so its separate components cannot be identified.