Systematic review of the effectiveness of cognitive-oriented interventions for reducing behavioral and psychological symptoms of dementia (BPSD)

Objective: To primarily review the best evidence of reality orientation, cognitive stimulation, and reminiscence therapy on reducing BPSD, and secondarily to gain an insight into the impact of the cognitive-oriented interventions on associated factors in terms of patient's quality of life and caregiver's burden. Methods: A systematic review of eligible trials related to the reality orientation, cognitive stimulation, or reminiscence therapy and involved any of the aspects of BPSD was performed. Articles identified on three electronic databases (PubMed, CINAHL and PsycINFO) that were published in English and available in full-text, and met the inclusion criteria were included. The Physiotherapy Evidence Database Scale (PEDro) was used for the appraisal of the articles. Results: A total of 15 studies (12 RCTs, 1 NRCT and 2 UCTs) met the inclusion criteria and nine of the studies were rated high quality on PEDro scale. Eleven studies showed significant improvement in at least one of the aspects of BPSD, and apathy was the symptom most studies found improved. Three studies found significant improvement in the patientâ??s quality of life and another two in the caregiver's burden. Conclusion: Despite an inconclusive result due to the methodological heterogeneity of the trials, the application of cognitive-oriented interventions seems to be promising in improving neuropsychiatric symptoms particularly apathy, patientâ??s QoL, and caregiverâ??s burden. Conducting cognitive-oriented interventions at home and by family members or caregivers could be an emerging trend.
Author(s): Frank Ho-yin Lai and Crystal FUNG

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