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Psychiatry Investig > Volume 15(4); 2018 > Article
Na, Kim, Kim, and Kim: A Systematic Review of Nonpharmacological Interventions for Moderate to Severe Dementia: A Study Protocol for a Systematic Review and Meta-Analysis

Abstract

The study is designed as a systematic review on nonpharmacological interventions for patients with moderate to severe dementia. This review will be conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. The following databases will be searched: Cochrane CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO, KoreaMED, KMbase, and KISS. The primary outcome will include the effect of the interventions on activities of daily living and behavioral and psychological symptoms of dementia. The literature search will be conducted based on search strategies designed for each database. The reviewers will independently assess the identified studies and extract the data. The risk of bias will be assessed and a meta-analysis will be conducted in accordance with the methodology for meta-analysis described in the Cochrane handbook. This systematic review will provide clinicians and policy makers with reliable evidence for developing and implementing nonpharmacological interventions for moderate to severe patients with dementia.

INTRODUCTION

Dementia is a common neuropsychiatric syndrome that is usually chronic or progressive and causes deterioration of various mental functions, including cognitive, emotional, and mental [1]. Dementia results in deterioration of the quality of life (QoL) of people with dementia (PWD) and their caregivers [2] and the imposition of an enormous economic burden on the families of PWD and the public healthcare system [2,3]. The global epidemic of dementia has caused pertinent global costs to rapidly increase. In 2010, the cost was 604 billion USD, and it is expected to reach 1 trillion USD by 2018 [4].
Unfortunately, a cure for dementia has not been found. Although pharmacological agents, such as acetylcholinesterase inhibitors and N-methyl-D-aspartate receptor antagonists, are effective for temporary control of the symptoms of cognitive decline and improvement of the activities of daily living (ADL) of patients with Alzheimer’s disease (AD), they cannot restore premorbid levels of function or maintain adequate levels of function in patients in later stages of dementia [5,6]. Furthermore, medications, such as antipsychotics, should be sparingly used to manage the behavioral and psychological symptoms of dementia (BPSD) due to the risk of adverse events, including cerebrovascular events, tardive dyskinesia, neuroleptic malignant syndrome, agranulocytosis, and mortality [7,8]. Therefore, multifactorial therapeutic approaches that include pharmacological and nonpharmacological interventions (NPIVs) are increasingly advocated to improve the cognitive, affective, and global functioning of PWD, particularly for those in the later stages of dementia [7,9-11].
Recent systematic reviews have shown that several NPIVs may improve the cognition, communication, interactions, BPSD, ADL, and/or QoL of PWD [12-15]. However, many of these reviews did not conduct meta-analyses due to lack of qualified studies and/or excessive study heterogeneity [16-23]. Furthermore, most studies on NPIVs did not consider the severity of dementia or included PWD in the later stages [16-18,24-30], and the efficacy and/or mechanisms of NPIVs may differ in later stages of dementia compared to those in the earlier stages [7,8]. Although three systematic reviews on the efficacy of NPIVs in people with moderate to severe dementia (PWMSD) have been conducted, the effect sizes of the NPIVs were not reported because the reviews were not meta-analyses. Furthermore, the times of publication or intervention settings of the studies included in the meta-analyses were limited [16,17,23,31,32].
The principal strength of a systematic review is the capacity to identify salient and critical studies through the unmanageable numbers of existing medical literature using critical exploration, valuation, and synthesis [33]. Second, the results of a systematic review could satisfy the need of decision makers for evidence-based integrated results [33]. Conducting a systematic review, it is possible to refine the literature on the efficacy of NPIV in PWMSD by conducting qualitative synthesis and quantitative analysis, and also provide decision makers with reliable and pertinent evidence.

METHODS

Purpose

This systematic review, which will include a meta-analysis, aims to identify and evaluate the efficacy of NPIVs on the ADL and BPSD of PWMSD. Thus, the proposed systematic review will attempt to answer the following research questions:
  • 1) Which NPIVs improve the ADL and BPSD of PWMSD?

  • 2) What are the effects of NPIVs on the ADL and BPSD of PWMSD?

Methodology

This systematic review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement [34] and Cochrane Handbook for Systematic Reviews of Interventions [35]. This systematic review protocol is registered with the PROSPERO (CRD42017058020) [36].

Eligibility criteria

Populations

The systematic review will include studies involving people diagnosed with any type of dementia according to the criteria in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III); Fourth Edition, Text Revision (DSMIV-TR); or Fifth Edition (DSM-5); International Classification of Diseases, Tenth Revision (ICD-10); or other accepted diagnostic criteria.
This systematic review will include PWD in the moderate to severe stages who met one of the following criteria: Clinical Dementia Rating score of 2 or more, Global Deterioration Scale score of 5 or more, Functional Assessment Staging score of 5 or more, Mini-Mental State Examination (MMSE) score of 20 or less, or Revised Hasegawa’s Dementia Scale score of 20 or less.

Interventions

This systematic review will include studies involving any type of NPIV that were conducted in community settings or institutional settings. NPIVs can be categorized in four broad groups following the practice guideline [8], and we will include several treatments such as cognitive therapy, art therapy, aromatherapy, massage, animal assisted therapy, exercise, or horticultural therapy.

Outcomes

This systematic review will employ ADL and BPSD as the primary outcomes and cognitive function and QoL as the secondary outcomes.

Study design

This systematic review will include randomized control trials (RCTs), quasi RCTs, non RCTs, cross-sectional studies, interrupted time series, and before-after studies that used the Study Design Algorithm for Medical Literature on Intervention [37].

Information sources

This systematic review will search the following databases and reference lists of the included studies: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE®, EMBASE®, CINAHL, PsycINFO, KoreaMED, KMbase, and KISS. This systematic review will not limit the geography or time of the study, but only publications written in English or Korean will be included.

Search strategy

One reviewer (R Na) will search the information sources. The search strategy will include the study population and intervention terms suggested by Medical Subject Headings (MeSH®) and Emtree®. The search terms will be adapted for use in other bibliographic databases with database-specific filters when available. Some syntax, including truncation, or Boolean operators, will be amended to the specific databases. A draft EMBASE search strategy is shown in Table 1. This EMBASE search strategy will be adapted to the syntax and subject headings of the other databases.

Study records

Data management

This systematic review will export the search results to End-Note X8.0.1 [Clarivate Analytics (formerly Thomson Reuters), Philadelphia, PA, USA] in which all reference records will be managed.

Selection process

Two reviewers (R Na and YJ Kim) will independently select studies in the three phases listed below. If any discrepancies occur between the two reviewers, two additional reviewers (KW Kim and K Kim) will amend the decision. This systematic review will create a PRISMA flow diagram of the included and excluded studies.
  • 1) Initial screening: potential papers will be identified for abstract retrieval, and any obviously irrelevant studies will be eliminated by screening their titles.

  • 2) Secondary screening: potential papers will be identified for full text retrieval by screening their abstracts.

  • 3) Tertiary screening: papers that should be included in the current systematic review will be identified by reading the full text, and the reasons for exclusion will be documented.

Data collection process

Two reviewers (R Na and YJ Kim) will collect the data. Eligible data will be independently extracted with a standardized form. Any discrepancies will be resolved by deliberation between R Na and YJ Kim or, if needed, with two other reviewers (KW Kim and K Kim).

Data items

Two reviewers (R Na and YJ Kim) will extract the data from the publications with a standardized data extraction form. The extracted data will be summarized as shown in Table 2.

Outcomes and prioritization

Primary outcomes

The primary outcomes of this systematic review will be ADL and BPSD of PWMSD. ADL, which will include Basic and Instrumental ADL [38], will be measured with standardized assessment scales, including the AD Cooperative Study’s ADL scale, Barthel Index, Disability Assessment for Dementia, D-Scale of Change, Katz Index, modified instrumental ADL scale, modified Physical Self-Maintenance Scale, Functional Independence Measure, and Nurse Informant Index of Activities of Daily Living [12,38-43].
The other primary outcome, BPSD, represents a heterogeneous group of noncognitive symptoms and behaviors [44]. BPSD includes agitation, aggression, aberrant motor behavior, anxiety, elation, irritability, depression, dysphoria, apathy, disinhibition, delusions, hallucinations, appetite or eating changes, euphoria, sleep and night-time behavior changes, vegetative features, fear, phobia, wandering, threat, violence, fearfulness, diurnal rhythm disturbances, psychosis, and mood changes [44-47]. BPSD assessments require standardized clinical assessments, such as the Behavioral Pathology in AD Scale, Neuropsychiatric Inventory, Behavior Rating Scale for Dementia, Cornell Scale for Depression in Dementia, Geriatric Depression Scale, Behavior and Mood Disturbance Scale, Rehabilitation Evaluation of Hall and Baker, Clifton Assessment Procedures for the Elderly, Cohen-Mansfield Agitation Inventory, and Actigraphy [31,44,48-51].

Secondary outcomes

The secondary outcomes will include the cognitive function and QoL of PWD. Cognitive function will be measured with standardized assessment tools, such as the Mini-Mental State Examination (MMSE), Severe Impairment Battery, Kingston Dementia Rating Scale, AD Assessment Scale-Cognitive Subscale, Brief Cognitive Screening Battery, Consortium to Establish a Registry for AD Assessment Tool (Korean version), Modified MMSE, and Montreal Cognitive Assessment [12,32,52-54]. The evaluations of the QoL variables in PWD will require standardized and validated QoL scales, such as the Quality of Life scale in AD, AD Related Quality of Life, Dementia-Quality of Life, EuroQoL-Five Dimensions Questionnaire, and Blau’s QoL Scale [14,55-59].

Risk of bias in individual studies

Two reviewers (R Na and YJ Kim) will independently assess the risk of bias (RoB) in each study. All reviewers will discuss the quality of a study if the two reviewers disagree. The RoB of RCTs will be assessed with the RoB scale [60], while the RoB of nonRCTs will be assessed with the RoB Assessment Tool for Nonrandomized Studies (RoBANS) [61]. Each included study will be classified as low risk, high risk, or unclear according to the RoB and/or RoBANS.

Data synthesis

Two reviewers (YJ Kim and R Na) will conduct a meta-analysis of the outcomes with Review Manager if a sufficient number of studies are included. They will employ risk and odds ratios with 95% confidence intervals (CIs) for dichotomous outcomes and weighted mean differences (with 95% CIs) or standardized mean differences (with 95% CIs) for continuous outcomes. For missing data, we will attempt to contact the authors of the study to obtain the relevant information. Intention-to-treat data, if available, will be preferred.
This systematic review will consider the various characteristics of the participants and the study designs when evaluating the heterogeneity of the studies. Heterogeneity will be statistically tested with the chi-squared and I-squared tests [35]. To address heterogeneity, a meta-analysis will be conducted by considering the following: re-examining the data for accuracy, canceling the meta-analysis, exploring the heterogeneity, ignoring the heterogeneity, performing a random-effects meta-analysis, changing the effect measure, and/or excluding studies [35].
This systematic review will conduct subgroup analyses of the participants (e.g., dementia subtype, dementia severity, or participant characteristics), interventions (types, providers, or settings), study designs, and follow-up periods if sufficient data are available.

Meta-biases

This systematic review will assess publication bias with funnel plots of potential reporting bias if the number of studies in the meta-analysis is over 10.

Confidence in the cumulative estimates

This systematic review will assess the quality of the evidence for all outcomes with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) [62]. All reviewers will determine the quality of the evidence according to the GRADE guidelines [62-70].

CONCLUSION

This systematic review will examine the clinical efficacy of NPIVs on the ADL, BPSD, cognitive function, and QoL of PWMSD. Although the efficacy of NPIVs on PWD may differ according to the severity of dementia, recent reviews on NPIVs for PWD have not separately evaluated NPIVs efficacy on PWMSD or conducted relevant meta-analyses. To maximize the power of systematic reviews, restriction of publication language is not recommended. However, this systematic review will include studies written in English or Korean only for practical reasons, which will be a limitation of this study.
Nonetheless, this systematic review will provide clinicians and policy makers with reliable evidence for developing and implementing NPIVs for PWMSD.

ACKNOWLEDGEMENTS

This systematic review is supported by a grant from the National Institute of Dementia of Korea (Grant Number: NIDR-1703-0018), Republic of Korea.

Table 1.
Example of an advanced search strategy-EMBASE
1 ‘dementia’/exp
2 ‘alzheimer disease’/exp
3 ‘frontotemporal dementia’/exp
4 ‘lewy body’/exp
5 ‘multiinfarct dementia’/exp
6 ‘normotensive hydrocephalus’/exp
7 ‘huntington chorea’/exp
8 parkinson AND disease AND dementia
9 vascular AND dementia
10 alcohol AND related AND dementia
11 #1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10
12 moderate:ab,ti
13 severe:ab,ti
14 moderate AND to AND severe:ab,ti
15 advanced:ab,ti
16 profound:ab,ti
17 #12 OR #13 OR #14 OR #15 OR #16
18 #11 AND #17
19 ‘therapy’/exp
20 ‘cognitive therapy’/exp
21 ‘art therapy’/exp
22 ‘aromatherapy’/exp
23 ‘massage’/exp
24 ‘touch’/exp
25 ‘animal assisted therapy’/exp
26 ‘exercise’/exp
27 ‘horticultural therapy’/exp
28 ‘virtual reality’/exp
29 ‘telerehabilitation’/exp
30 (nonpharmacological AND treatment$) OR
(nonpharmacological AND therap$) OR
(nonpharmacological AND intervention$)
31 (nondrug AND treatment$) OR (nondrug AND therap$)
OR (nondrug AND intervention$)
32 emotion AND oriented AND intervention$:ab,ti
33 cognitive AND oriented AND intervention$:ab,ti
34 psychotherapy$:ab,ti
35 recreation AND therapy$:ab,ti
36 validation AND therapy$:ab,ti
37 reminiscence AND therapy$:ab,ti
38 sensory AND stimulation AND intervention$:ab,ti
39 light AND therapy$:ab,ti
40 music AND therapy$:ab,ti
41 (snoezelen:ab,ti) OR (snoezelen AND multisensory AND stimulation:ab,ti)
42 doll AND therapy$:ab,ti
43 robot AND therapy$:ab,ti
44 multimodal AND therapy$:ab,ti
45 occupational AND therapy$:ab,ti
46 behavi?r AND therapy$:ab,ti
47 computer AND assisted AND therapy$:ab,ti
48 reality AND orientation$:ab,ti
49 cognitive AND training$:ab,ti
50 #19 OR #20 OR #21 OR #22 OR #23 OR #24 OR #25 OR
#26 OR #27 OR #28 OR #29 OR #30 OR #31 OR #32 OR
#33 OR #34 OR #35 OR #36 OR #37 OR #38 OR #39 OR
#40 OR #41 OR #42 OR #43 OR #44 OR #45 OR #46 OR
#47 OR #48 OR #49
51 #18 AND #50
52 ‘randomized controlled trial’/exp
53 ‘multicenter study’/exp
54 ‘clinical trial’/exp
55 ‘randomization’/exp
56 ‘single blind procedure’/exp
57 ‘crossover procedure’/exp
58 ‘placebo’/exp
59 ‘prospective study’/exp
60 double AND blind AND procedure
61 randomi?ed AND controlled AND trial$
62 rct:ab,ti
63 random AND allocation
64 randomly AND allocated
65 allocated AND randomly
66 single AND blind$:ab,ti
67 double AND blind$:ab,ti
68 cross AND sectional AND study
69 before AND after AND study
70 #52 OR #53 OR #54 OR #55 OR #56 OR #57 OR #58 OR
#59 OR #60 OR #61 OR #62 OR #63 OR #64 OR #65 OR
#66 OR #67 OR #68 OR #69
71 ‘retrospective study’/exp
72 ‘cohort’/exp
73 ‘letter’/exp
74 case AND report
75 case AND study
76 abstract AND report
77 #71 OR #72 OR #73 OR #74 OR #75 OR #76
78 #70 NOT #77
79 #51 AND #78
80 animal
81 human
82 #80 NOT (#80 AND #81)
83 #79 NOT #82
Table 2.
Data extraction variables
Content Data items
Prospective study information Author(s), Year of publication, Country
Study design Trial design
Number of participants Number of participants invited, number of participants screened, number of participants eligible, number of participants randomized, reasons for non-eligibility, reasons for drop-out
Population Severity of dementia, Type of dementia (e.g. Alzheimer’s disease, vascular dementia, dementia with Lewy bodies, frontotemporal dementia, etc.) Average age, Gender, ethnicity, Diagnostic criteria for dementia (e.g. DSM-III, DSM-IV, DSM-5, ICD-10, etc.), Diagnostic tool for severity of dementia (e.g. CDR, GDS, FAST, MMSE, etc.), Physical health comorbidity, Usage of antidementia drug
Intervention Name of treatment group, Type of non-pharmacological intervention, Frequency and duration of intervention, Intervention provider, length of intervention session, Mode of delivery (e.g. individual, group, combination)
Comparison Name and type of control group, Frequency and duration of intervention, Intervention provider, length of intervention session, Mode of delivery (e.g. individual, group, combination)
Outcome Detail of outcome measure
Outcome measure Baseline, Follow-up assessment, Losses to follow-up, Result
Follow-up Duration of follow-up, Drop-out rate
Setting Community, Institution

DSM-III: Diagnostic and Statistical Manual of Mental Disorders, Third Edition, DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, DSM-5: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, ICD-10: International Classification of Diseases, Tenth Revision, CDR: Clinical Dementia Rating, GDS: Global Deterioration Scale, FAST: Functional Assessment Staging, MMSE: Mini-Mental State Examination

REFERENCES

1. Organization WH. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva: World Health Organization; 1992.

2. Cho H, Ko Z. Current state of senile dementia and improvement of the long term care insurance for elderly people. J Kor Acad Industr Coop Soc 2012;13:5816-5825.
crossref pdf
3. Organization WH. First WHO Ministerial Conference on Global Action against Dementia: Meeting Report, WHO Headquarters. Geneva, Switzerland. 16-17 March, 2015.

4. Prince MJ. World Alzheimer Report 2015: the Global Impact of Dementia: An Analysis of Prevalence, Incidence, Cost and Trends. London: Alzheimer’s Disease International; 2015.

5. Gardette V, Coley N, Andrieu S. Non-pharmacologic therapies: a different approach to ad. Can Rev of Alz Dis Other Dem 2010;13:13-22.

6. O’Hara R, Mumenthaler MS, Yesavage JA. Update on Alzheimer’s disease: recent findings and treatments. West J Med 2000;172:115-120.
crossref pmid pmc
7. Committee GA. Clinical Practice Guidelines and Principles of Care for People with Dementia. Sydney: Guidelines Adaptation Committee; 2016.

8. Rabins PV, Blacker D, Rovner BW, Rummans TA, Schneider LS, Tariot PN, et al. American Psychiatric Association practice guideline for the treatment of patients with Alzheimer’s disease and other dementias. Am J Psychiatry 2007;164(12 Suppl):5-56.

9. Han JW, Oh K, Yoo S, Kim E, Ahn KH, Son YJ, et al. Development of the ubiquitous spaced retrieval-based memory advancement and rehabilitation training program. Psychiatry Investig 2014;11:52-58.
crossref pmid pmc
10. Jean L, Bergeron ME, Thivierge S, Simard M. Cognitive intervention programs for individuals with mild cognitive impairment: systematic review of the literature. Am J Geriatr Psychiatry 2010;18:281-296.
crossref pmid
11. Yesavage JA, Westphal J, Rush L. Senile dementia: combined pharmacologic and psychologic treatment. J Am Geriatr Soc 1981;29:164-171.
crossref pmid
12. Forbes D, Blake CM, Thiessen EJ, Peacock S, Hawranik P. Light therapy for improving cognition, activities of daily living, sleep, challenging behaviour, and psychiatric disturbances in dementia. Cochrane Database Syst Rev 2014;(2):CD003946.
crossref pmid
13. Forrester LT, Maayan N, Orrell M, Spector AE, Buchan LD. Soares Weiser K. Aromatherapy for dementia. Cochrane Database Syst Rev 2014;(2):CD003150.
pmid
14. Orgeta V, Qazi A, Spector AE, Orrell M. Psychological treatments for depression and anxiety in dementia and mild cognitive impairment. Cochrane Database Syst Rev 2014;(1):CD009125.
pmid
15. Woods B, Aguirre E, Spector AE, Orrell M. Cognitive stimulation to improve cognitive functioning in people with dementia. Cochrane Database Syst Rev 2012;(2):CD005562.
pmid
16. de Oliveira AM, Radanovic M, de Mello PC, Buchain PC, Vizzotto AD, Celestino DL, et al. Nonpharmacological interventions to reduce behavioral and psychological symptoms of dementia: a systematic review. Biomed Res Int 2015;2015:218980. doi: 10.1155/2015/218980.
crossref pmid pmc pdf
17. Brodaty H, Arasaratnam C. Meta-analysis of nonpharmacological interventions for neuropsychiatric symptoms of dementia. Am J Psychiatry 2012;169:946-953.
crossref pmid
18. Littbrand H, Stenvall M, Rosendahl E. Applicability and effects of physical exercise on physical and cognitive functions and activities of daily living among people with dementia: a systematic review. Am J Phys Med Rehabil 2011;90:495-518.
crossref pmid
19. Hermans D, Htay U, Cooley SJ. Non pharmacological interventions for wandering of people with dementia in the domestic setting. Cochrane Database Syst Rev 2007;(90):CD005994.
crossref pmid
20. Hansen NV, Jørgensen T, Ørtenblad L. Massage and touch for dementia. Cochrane Database Syst Rev 2006;(4):CD004989.
crossref pmid
21. Neal M, Briggs M. Validation therapy for dementia. Cochrane Database Syst Rev 2000;(2):CD001394.
crossref pmid
22. Vink AC, Bruinsma MS, Bruinsma MS, Scholten RJ. Music therapy for people with dementia. Cochrane Database Syst Rev 2004;(3):CD003477.
crossref pmid
23. Chung JC, Lai CK, Chung PM, French HP. Snoezelen for dementia. Cochrane Database Syst Rev 2002;(4):CD003152.
crossref pmid
24. Brasure M, Jutkowitz E, Fuchs E, Nelson VA, Kane RA, Shippee T, et al. Nonpharmacologic Interventions for Agitation and Aggression in Dementia. Rockville, MD: Agency for Healthcare Research and Quality (US); 2016.Report No.: 16-EHC019-EF.

25. Spector A, Orrell M, Lattimer M, Hoe J, King M, Harwood K, et al. Cognitive behavioural therapy (CBT) for anxiety in people with dementia: study protocol for a randomised controlled trial. Trials 2012;13:197.
crossref pmid pmc pdf
26. Buschert VC, Friese U, Teipel SJ, Schneider P, Merensky W, Rujescu D, et al. Effects of a newly developed cognitive intervention in amnestic mild cognitive impairment and mild Alzheimer’s disease: a pilot study. J Alzheimers Dis 2011;25:679-694.
crossref pmid
27. O’Neil ME, Freeman M, Christensen V, Telerant R, Addleman A, Kansagara D, et al. A systematic evidence review of non-pharmacological interventions for behavioral symptoms of dementia. Washington, DC: Department of Veterans Affairs; 2011.

28. Bottino CM, Carvalho IA, Alvarez AMM, Avila R, Zukauskas PR, Bustamante SE, et al. Cognitive rehabilitation combined with drug treatment in Alzheimer’s disease patients: a pilot study. Clin Rehabil 2005;19:861-869.
crossref pmid
29. Burns A, Guthrie E, Marino-Francis F, Busby C, Morris J, Russell E, et al. Brief psychotherapy in Alzheimer’s disease. Br J Psychiatry 2005;187:143-147.
crossref pmid
30. Chapman SB, Weiner MF, Rackley A, Hynan LS, Zientz J. Effects of cognitive-communication stimulation for Alzheimer’s disease patients treated with donepezil. J Speech Lang Hear Res 2004;47:1149-1163.
crossref pmid
31. Kverno KS, Black BS, Nolan MT, Rabins PV. Research on treating neuropsychiatric symptoms of advanced dementia with non-pharmacological strategies, 1998-2008: a systematic literature review. Int Psychogeriatr 2009;21:825-843.
crossref pmid pmc
32. Boote J, Lewin V, Beverley C, Bates J. Psychosocial interventions for people with moderate to severe dementia: a systematic review. Clin Effect Nurs 2006;9(Suppl 1):e1-e15.
crossref
33. Mulrow CD. Rationale for systematic reviews. BMJ 1994;309:597-599.
crossref pmid pmc
34. Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ 2015;349:g7647.
crossref
35. Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions. West Sussex: John Wiley & Sons; 2011.

36. Kim KW, Kim K, Kim YJ, Na R. A systematic review of non-pharmacological interventions for moderate to severe dementia. PROSPERO 2017 CRD42017058020 Available from: http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017058020.

37. Seo HJ, Kim SY, Lee YJ, Jang BH, Park JE, Sheen SS, et al. A newly developed tool for classifying study designs in systematic reviews of interventions and exposures showed substantial reliability and validity. J Clin Epidemiol 2016;70:200-205.
crossref pmid
38. Buzaid A, Dodge MP, Handmacher L, Kiltz PJ. Activities of daily living: evaluation and treatment in persons with multiple sclerosis. Phys Med Rehabil Clin N Am 2013;24:629-638.
crossref pmid
39. Hartigan I. A comparative review of the Katz ADL and the Barthel Index in assessing the activities of daily living of older people. Int J Older People Nurs 2007;2:204-212.
crossref pmid
40. Aisen PS, Schafer KA, Grundman M, Pfeiffer E, Sano M, Davis KL, et al. Effects of rofecoxib or naproxen vs placebo on Alzheimer disease progression: a randomized controlled trial. JAMA 2003;289:2819-2826.
crossref pmid
41. Feldman H, Gauthier S, Hecker J, Vellas B, Emir B, Mastey V, et al. Efficacy of donepezil on maintenance of activities of daily living in patients with moderate to severe Alzheimer’s disease and the effect on caregiver burden. J Am Geriatr Soc 2003;51:737-744.
crossref pmid
42. Rüther E, Glaser A, Bleich S, Degner D, Wiltfang J. A prospective PMS study to validate the sensitivity for change of the D-scale in advanced stages of dementia using the NMDA-antagonist memantine. Pharmacopsychiatry 2000;33:103-108.
crossref pmid pdf
43. Gélinas I, Gauthier L, McIntyre M, Gauthier S. Development of a functional measure for persons with Alzheimer’s disease: the disability assessment for dementia. Am J Occup Ther 1999;53:471-481.
crossref pmid
44. Cerejeira J, Lagarto L, Mukaetova-Ladinska E. Behavioral and psychological symptoms of dementia. Front Neurol 2012;3:73.
crossref pmid pmc
45. Pilotto A, Ferrucci L, Franceschi M, D’Ambrosio LP, Scarcelli C, Cascavilla L, et al. Development and validation of a multidimensional prognostic index for one-year mortality from comprehensive geriatric assessment in hospitalized older patients. Rejuvenation Res 2008;11:151-161.
crossref pmid pmc
46. Jacobs MR, Strauss ME, Patterson MB, Mack JL. Characterization of depression in Alzheimer’s disease by the CERAD Behavior Rating Scale for Dementia (BRSD). Am J Geriatr Psychiatry 1998;6:53-58.
pmid
47. Reisberg B, Auer SR, Monteiro IM. Behavioral pathology in Alzheimer’s disease (BEHAVE-AD) rating scale. Int Psychogeriatr 1996;8(Suppl 3):301-308.
crossref pmid
48. Kørner A, Lauritzen L, Abelskov K, Gulmann N, Marie Brodersen A, Wedervang-Jensen T, et al. The geriatric depression scale and the cornell scale for depression in dementia. A validity study. Nord J Psychiatry 2006;60:360-364.
crossref pmid
49. Tariot PN, Mack JL, Patterson MB, Edland SD, Weiner MF, Fillenbaum G, et al. The behavior rating scale for dementia of the consortium to establish a registry for Alzheimer’s disease. Am J Psychiatry 1995;152:1349-1357.
crossref pmid
50. Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J. The neuropsychiatric inventory comprehensive assessment of psychopathology in dementia. Neurology 1994;44:2308-2314.
crossref pmid
51. Alexopoulos GS, Abrams RC, Young RC, Shamoian CA. Cornell scale for depression in dementia. Biol Psychiatry 1988;23:271-284.
crossref pmid
52. Sink KM, Craft S, Smith SC, Maldjian JA, Bowden DW, Xu J, et al. Montreal cognitive assessment and modified mini mental state examination in African Americans. J Aging Res 2015;2015:872018. doi:10.1155/2015/872018.
crossref pmid pmc pdf
53. Doraiswamy PM, Kaiser L, Bieber F, Garman RL. The Alzheimer’s Disease Assessment Scale: evaluation of psychometric properties and patterns of cognitive decline in multicenter clinical trials of mild to moderate Alzheimer’s disease. Alzheimer Dis Assoc Disord 2001;15:174-183.
crossref pmid
54. Panisset M, Roudier M, Saxton J, Boiler F. Severe impairment battery. A neuropsychological test for severely demented patients. Arch Neurol 1994;51:41-45.
crossref pmid
55. González Salvador T, Lyketsos CG, Baker A, Hovanec L, Roques C, Brandt J, et al. Quality of life in dementia patients in long term care. Int J Geriatr Psychiatry 2000;15:181-189.
crossref pmid
56. Hoe J, Katona C, Roch B, Livingston G. Use of the QOL-AD for measuring quality of life in people with severe dementia-the LASER-AD study. Age Ageing 2005;34:130-135.
crossref pmid pdf
57. Ankri J, Beaufils B, Novella JL, Morrone I, Guillemin F, Jolly D, et al. Use of the EQ-5D among patients suffering from dementia. J Clin Epidemiol 2003;56:1055-1063.
crossref pmid
58. Rabins P. Measuring quality of life in persons with dementia. Int Psychogeriatr 2000;12(Supp 1):47-49.
crossref
59. Brod M, Stewart AL, Sands L, Walton P. Conceptualization and measurement of quality of life in dementia: the dementia quality of life instrument (DQoL). Gerontologist 1999;39:25-36.
crossref pmid pdf
60. Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928.
crossref pmid pmc
61. Kim SY, Park JE, Lee YJ, Seo HJ, Sheen SS, Hahn S, et al. Testing a tool for assessing the risk of bias for nonrandomized studies showed moderate reliability and promising validity. J Clin Epidemiol 2013;66:408-414.
crossref pmid
62. Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, et al. GRADE guidelines: 1. Introduction GRADE evidence profiles and summary of findings tables. J Clin Epidemiol 2011;64:383-394.
crossref pmid
63. Guyatt GH, Oxman AD, Kunz R, Atkins D, Brozek J, Vist G, et al. GRADE guidelines: 2. Framing the question and deciding on important outcomes. J Clin Epidemiol 2011;64:395-400.
crossref pmid
64. Balshem H, Helfand M, Schünemann HJ, Oxman AD, Kunz R, Brozek J, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol 2011;64:401-406.
crossref pmid
65. Guyatt GH, Oxman AD, Vist G, Kunz R, Brozek J, Alonso-Coello P, et al. GRADE guidelines: 4. Rating the quality of evidence-study limitations (risk of bias). J Clin Epidemiol 2011;64:407-415.
crossref pmid
66. Guyatt GH, Oxman AD, Montori V, Vist G, Kunz R, Brozek J, et al. GRADE guidelines: 5. Rating the quality of evidence-publication bias. J Clin Epidemiol 2011;64:1277-1282.
crossref pmid
67. Guyatt GH, Oxman AD, Kunz R, Brozek J, Alonso-Coello P, Rind D, et al. GRADE guidelines 6. Rating the quality of evidence-imprecision. J Clin Epidemiol 2011;64:1283-1293.
crossref pmid
68. Guyatt GH, Oxman AD, Kunz R, Woodcock J, Brozek J, Helfand M, et al. GRADE guidelines: 7. Rating the quality of evidence-inconsistency. J Clin Epidemiol 2011;64:1294-1302.
crossref pmid
69. Guyatt GH, Oxman AD, Kunz R, Woodcock J, Brozek J, Helfand M, et al. GRADE guidelines: 8. Rating the quality of evidence-indirectness. J Clin Epidemiol 2011;64:1303-1310.
crossref pmid
70. Guyatt GH, Oxman AD, Sultan S, Glasziou P, Akl EA, Alonso-Coello P, et al. GRADE guidelines: 9. Rating up the quality of evidence. J Clin Epidemiol 2011;64:1311-1316.
crossref pmid
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