Abstract
Systematic review briefs provide a summary of the findings from systematic reviews evaluated in conjunction with the American Occupational Therapy Association’s Evidence-Based Practice Program. Each systematic review brief summarizes the evidence on a theme related to a systematic review topic. This systematic review brief presents finding related to interventions within the scope of occupational therapy that address behavioral and psychological symptoms of dementia.
Full Systematic Review Question
This systematic review addressed the question “What is the evidence for the effectiveness of interventions within the scope of occupational therapy practice to improve performance and participation for people living with Alzheimer’s disease and other neurocognitive disorders and their care partners?”
Current Theme Reported
This systematic review brief focuses on interventions addressing behavioral and psychological symptoms of dementia (BPSD).
Clinical Scenario
Globally, there are approximately 55 million adults with dementia, and this number is expected to double every 20 yr to a projected 139 million cases by 2050 (World Health Organization, 2022). In addition to a deterioration in functional cognition, most adults with dementia experience altered perception, thoughts, mood, or behavior, otherwise known as BPSD (Kales et al., 2015; Serra et al., 2020). Specifically, BPSD can include agitation, irritability, depression, apathy, repetitive questioning, psychosis, aggression, difficulty sleeping, wandering, and inappropriate behavior (Kales et al., 2015; Serra et al., 2020). These symptoms can be difficult for formal and informal care providers to observe and manage and can lead to additional challenges, such as decreased health outcomes, increased health care costs, caregiver stress and burnout, and more (Kales et al., 2015). Additionally, BPSD can impair the ability to complete desired occupations or hinder the ability for care partners to support the performance of daily occupations. Occupational therapy practitioners working with adults with dementia frequently collaborate with clients, care partners, and other members of the health care team to address BPSD to maximize participation in daily life activities. Although many potential nonpharmacologic interventions have been studied, the purpose of this systematic review brief is to summarize the literature regarding interventions within the scope of occupational therapy that are effective in addressing BPSD in adults with dementia.
Summary of Key Findings
Six systematic reviews were included in this brief related to interventions addressing BPSD among adults with dementia and mild cognitive impairment (MCI). Interventions addressing outcomes of BPSD are included as subthemes. Interventions include reminiscence, music therapy (MT), exercise, cognitive-based intervention, cognitive behavioral intervention, and nonpharmacological interventions (Table 1). The levels of evidence used in this review are from Oxford Centre for Evidence-Based Medicine (2009). The strength-of-evidence designations are based on the guidelines of the U.S. Preventive Services Task Force (2018).
Evidence Table for Interventions Addressing Behavioral and Psychological Symptoms of Dementia Among Adults With Dementia and Mild Cognitive Impairment
Note: AD = Alzheimer’s disease; BPSD = behavioral and psychological symptoms of dementia; Dx = diagnosis; CBI = cognitive based intervention; CBT = cognitive behavioral therapy; MA = meta-analysis; MCI = mild cognitive impairment; MI = music interventions; NR = not reported; OT = occupational therapy; RCTs = randomized controlled trials; RoB = risk of bias; RT = reminiscence therapy; SR = systematic review; wk = week.
Bottom Line for Occupational Therapy Practice
The number of adults who will experience dementia will substantially increase in the coming years, and most of them will experience BPSD at some point during the disease process. These symptoms of dementia limit meaningful engagement in daily life activities. Several interventions within the scope of occupational therapy are effective in managing BPSD. Specifically, evidence for interventions based on symptoms is available. These strategies include reminiscence therapy, music interventions, cognitive-based intervention, and exercise, as well as education, skill training, support, case management, and multicomponent interventions for care partners or dyads. These strategies and interventions should be offered routinely, shared with occupational therapy service users, and integrated into daily habits and routines of those with dementia. Due to the growing number of adults with dementia, we recommend current and future occupational therapy practitioners working with this population be trained and prepared to share this information to support those with dementia as well as with the formal and informal care partners who support them. Based on current evidence, occupational therapy practitioners may consider program development and primary care opportunities in which the recommended interventions (i.e., reminiscence, music, exercise) can be integrated into the daily routine of those with dementia. Furthermore, care partner education and training should occur in the early phases of the disease process to enhance uptake of these strategies. Given that current evidence demonstrates that nondrug interventions are more effective than drug interventions alone at managing BPSD (Watt et al., 2021), occupational therapy practitioners play an important role on the health care team in ensuring adults with dementia and their care partners are equipped with effective strategies to enhance meaningful engagement in daily activities while living with BPSD.
Footnotes
*
Indicates articles included in the brief systematic review.
Acknowledgments
The authors thank Payton Swanson and Danielle Adams, University of Nebraska Medical Center occupational therapy doctoral students, for research assistance to prepare this brief.