Alltagsbewältigung bei Demenz: Medikamentöse und nicht medikamentöse Interventionen zeigen kleine Effekte auf heterogenen Skalen

 

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Zusammenfassung

Anliegen Die Wirkung medikamentöser und nicht medikamentöser Interventionen auf Alltagsaktivitäten demenzerkrankter Patienten sowie die methodische Heterogenität in der Erfassung werden dargelegt. Methode Die Synopse von 4 Übersichtsarbeiten wurde um eine Itemübersicht der eingesetzten Messinstrumente ergänzt. Ergebnisse Die Analyse zeigte keine Effekte für psychosoziale Interventionen, nur kleine für Galantamin, Rivastigmin und Memantin sowie Hinweise auf positive Effekte für Donepezil, ginkgohaltige Präparate und Angehörigenschulung. Schlussfolgerung Harmonisierung der Messinstrumente und weitere Forschung sind dringend erforderlich.

Abstract

Objective To assess the effects of pharmacological and non-pharmacological interventions on activities of daily living in dementia and the heterogeneity of the applied measurement instruments. Methods Four Health Technology Assessments (HTA) on dementia are summarized regarding to effects on activities of daily living. These HTA assessed RCTs on ACE-inhibitors, Memantin, Ginkgo and non-pharmacological interventions according to Cochrane standards. An overview over the domains of activities of daily living covered by the applied assessment instruments is provided. Results The analysis of 40 RCTs revealed indications of a beneficial effect of Donepezil, small positive effects of Galantamin, Rivastigmin and Memantin, positive effects of caregiver training in only one of five RCTs and no beneficial effects in seven RCTs on validation and reminiscence therapy, cognitive training procedures or activity-based interventions. Conclusion The studies demonstrated a very heterogeneous methodological quality with regard to assessment instruments, measurement time points and report of study design and results. Harmonisation in research methods is imperative and further elaborated RCTs must be conducted.

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Sebastian Voigt-Radloff

Zentrum für Geriatrie und Gerontologie, Universitätsklinikum Freiburg

Lehener Straße 88

79106 Freiburg

Email: sebastian.voigt@uniklinik-freiburg.de