Behavioral and psychological symptoms(BPSD) are seen in 60% to 98% of dementia cases. Non-pharmacological management is recommended as a first-line treatment for these symptoms. Exploring the effectiveness and advantages of various non-drug interventions for BPSD is the first step in scientific management of BPSD.
This study was a systematic review of randomized controlled trials of non-pharmacological interventions for BPSD by network meta-analysis.
This study comprehensively searched Chinese and English databases to obtain relevant literature. The methodological quality of the included literature was evaluated by the “biased risk assessment” tool which was recommended by Cochrane Handbook. In the network meta-analysis, the data extracted from the literature was statistically analyzed by R software.
A total of 5,370 related articles were retrieved, and 41 articles meeting the requirements were finally included. Network meta-analysis results show that reminiscence therapy(RT) can significantly reduce patients' NPI scores, and the difference is statistically significant (MD = -10.42, 95% CrI = -19.36 ~ -1.41), and the effect is better than individualized nursing(IN), massage therapy(MT) and therapeutic recreation(TC)（Figure1）. Behavior therapy(BT) (MD=-5.87, 95%CrI=-9.64~-2.10) and individualized nursing (MD= -6.24,95%CrI= -8.49~-4.04) can significantly decreased the HAMD scores. But individualized nursing is better. Individualized nursing (MD = -4.77, 95% CrI = -8.47 ~ -1.46) and behavioral therapy (MD = -7.56, 95% CrI = -11.82 ~ -4.17) can reduce the patient's HAMA score, but behavioral therapy is better. Individualized nursing can significantly increase the MMSE score of patients(MD = 3.43, 95% CrI = 1.87 ~ 5.06), and the effect of individualized nursing is better than behavioral therapy, massage therapy and therapeutic recreationa. Individualized nursing can increase the patient's BI score (MD = 8.82, 95% CrI = 2.27 ~ 15.70), and the effect is better.
Reminiscence therapy is more effective in improving the neuropsychiatric symptoms of the elderly with dementia. Individualized nursing is more effective in improving the depression, cognitive function and ability of daily living in the elderly with dementia. Behavior therapy is more effective in improving the anxiety symptoms of the elderly with dementia. It is recommended to provide corresponding targeted interventions according to the different mental and behavioral symptoms of dementia patients, in order to provide effective care for the elderly with dementia.