A Systematic Evidence Review of Non-pharmacological Interventions for Behavioral Symptoms of Dementia

In 2004, the Office of the Assistant Deputy Under Secretary for Health for Policy and Planning estimated that the total number of Veterans with dementia would be as high as 563,758 in FY 2010. The VHA Office of Geriatrics and Extended Care (OGEC) in Patient Care Services has primary responsibility for coordination and direction of VHA dementia initiatives. OGEC convened an interdisciplinary Dementia Steering Committee (DSC) in December 2006, with the goal of making recommendations on comprehensive, coordinated care for Veterans with dementia. The behavioral symptoms that are associated with dementia, such as agitation/aggression, wandering, and sleep disturbances, are associated with increased caregiver burden, decreased quality of life for the patient, and increased healthcare costs. It is estimated that behavioral symptoms occur in as many as 90 percent of people with Alzheimer's disease (AD). Moreover, it is the behavioral symptoms that are most often cited by caregivers as the reason for the placement of individuals with dementia into residential care. Psychotropic medications are commonly used to reduce the frequency and severity of the behavioral symptoms of dementia. There is little evidence, however, that such interventions are effective, and their potential side effects are frequent and often hazardous. It has been reported that the use of atypical and typical antipsychotic medication is associated with the increased risk of death. Because of the limited benefits and the potential harms associated with psychotropic medications, non-pharmacological interventions for the behavioral symptoms associated with dementia may be an attractive alternative to pharmacological treatment. The purpose of this report is to review systematically the evidence on non-pharmacological treatments for behavioral symptoms of dementia. The DSC requested VA HSR&D's Evidence-based Synthesis Program (ESP) to review evidence on selected topics, in order to assist with DSC planning efforts. This evidence review addresses the following questions: Key Question #1. How do non-pharmacological treatments of behavioral symptoms compare in effectiveness with each other, with pharmacological approaches, and with no treatment? Key Question #2. How do non-pharmacological treatments of behavioral symptoms compare in safety with each other, with pharmacological approaches, and with no treatment? Key Question #3. How do non-pharmacological treatments of behavioral symptoms compare in cost with each other, with pharmacological approaches, and with no treatment?