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Systematic review of the efficacy of non-pharmacological interventions in people with Lewy body dementia

Published online by Cambridge University Press:  09 October 2017

Hamilton Morrin ,
Ton Fang ,
Donald Servant ,
Dag Aarsland  and
Anto P. Rajkumar Open the ORCID record for Anto P. Rajkumar [Opens in a new window]
Hamilton Morrin
Affiliation:
Guy's Hospital, King's College London, London, UK
Ton Fang
Affiliation:
Guy's Hospital, King's College London, London, UK
Donald Servant
Affiliation:
South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK
Dag Aarsland
Affiliation:
Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London, UK Mental Health of Older Adults and Dementia Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK
Anto P. Rajkumar*
Affiliation:
Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London, UK Mental Health of Older Adults and Dementia Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK
*
Correspondence should be addressed to: Anto P. Rajkumar, Clinical Lecturer, Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, 16, De Crespigny Park, London SE5 8AF, UK. Phone: +44-(0)-2078480508. Email: Anto.Rajamani@kcl.ac.uk.
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Abstract

Background:

Pharmacological interventions for Lewy body dementia (LBD), especially for its non-cognitive symptoms, are limited in their efficacy and tolerability. Clinicians are often uncertain about non-pharmacological interventions and their efficacy in managing cognitive and non-cognitive symptoms of LBD. Therefore, we aimed to systematically review the existing literature on non-pharmacological interventions for people with LBD.

Methods:

We carried out a systematic search using six databases. All human studies examining impact of any non-pharmacological intervention on LBD were assessed for cognitive, physical, psychiatric, and quality-of-life outcomes. Study quality was assessed by Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies and the CARE criteria checklist.

Results:

Prevailing evidence supporting the efficacy of non-pharmacological interventions is weak. We screened 1,647 papers. Fifteen studies (n = 61) including 11 case reports were found eligible for this systematic review. Interventions and reported outcomes were heterogeneous. Deep brain stimulation of the nucleus basalis of Meynert reportedly conferred cognitive benefit. Electroconvulsive therapy and repetitive transcranial magnetic stimulation have been reported to ameliorate depressive symptoms. Transcranial direct current stimulation was observed to improve attention. Exercise-based interventions reportedly improve various clinically important outcomes. Spaced retrieval memory training and environmental intervention for “mirror sign” have also been reported.

Conclusions:

Several non-pharmacological interventions have been studied in LBD. Although evidence supporting their efficacy is not robust, prevailing preliminary evidence and limitations of available pharmacological interventions indicate the need to consider appropriate non-pharmacological interventions, while planning comprehensive care of LBD patients. Larger trials evaluating the efficacy of non-pharmacological interventions for LBD are needed.

Keywords

dementia with Lewy bodiesParkinson's disease dementiadeep brain stimulationelectroconvulsive therapyrepetitive transcranial magnetic stimulationexercise
Type
Research Article
Information
International Psychogeriatrics , Volume 30 , Issue 3: Issue Theme: Psychosocial Interventions for Dementia , March 2018 , pp. 395 - 407
Copyright
Copyright © International Psychogeriatric Association 2017 

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