The effectiveness of non‐pharmacological interventions targeting neuropsychiatric symptoms among persons with preclinical and mild dementia: A systematic review and network meta‐analysis

Abstract

Objectives To conduct a systematic review and network meta‐analysis examining the effects of non‐pharmacological interventions on neuropsychiatric symptoms (NPS) in a community‐dwelling population with preclinical and mild dementia to identify the design characteristics of more effective interventions. Methods A comprehensive search was conducted in 10 electronic databases. Two reviewers independently appraised the methodological quality of studies using the Risk of Bias 2.0 tool. A pairwise meta‐analysis was performed to estimate the standardized mean differences (SMD) with 95% confidence intervals. Network meta‐analysis was then used to estimate the relative effects and rankings of different interventions. Results Twenty‐one studies involving 1773 participants were included. Seven studies focused on preclinical dementia, and 14 studies focused on mild dementia. The majority of studies reported a single domain of NPS (depression, anxiety, apathy or agitation) rather than overall NPS. Data on depression were pooled. Pairwise analysis and network meta‐analysis indicated that multimodal interventions (SMD = −0.47, p = 0.01) were superior to psycho‐behavioral educative interventions (SMD = −0.04; p = 0.65), cognitive training (SMD = −0.27, p = 0.10), and art‐based interventions for improving depression. The more crucial design characteristics included those that emphasized skill transferal into daily life, psycho‐behavioral content to encourage a positive outlook and self‐identity, and disease‐specific educational content to improve symptom management. Conclusions This review indicated that multimodal interventions with cognitive, psycho‐behavioral and educative components were the most effective approaches for improving depression in patients with preclinical and mild dementia. More comprehensive evaluations using standardized and robust measures of NPS in patients with preclinical dementia are warranted.

Lived experience of neuropsychiatric symptoms among females with mild cognitive impairment: A phenomenological study

“…This study revealed that the manifestations of NPS significantly compromise the quality of life of both the PwMCI and their family members. However, the current research efforts are highly focused on the management of cognitive symptoms, least attention was given to the co‐existing NPS (Lin et al, 2021). Thus, our findings suggested that instead of merely focusing on cognitive training, early identification and management of NPS at the preclinical stage are strongly indicated to secure the cognitive, social and psychological well‐being of the PwMCI.…”

Assessment and management pathways of older adults with mild cognitive impairment: descriptive review and critical interpretive synthesis

“…131 Therefore, delivering educative content on the condition is believed to have a stress-lowering effect and improve neuropsychiatric symptoms. 158 For patients, a diagnosis of MCI can profoundly affect a person's understanding of their place in the world. 23 Patients construct various explanations for memory problems.…”

Reliability and Validity of the Traditional Chinese Version of the Mild Behavioral Impairment – Checklist Among Persons With Mild Cognitive Impairment – A Validation Study

“…5 Currently, the mainstay of treatment is cognitive optimization, while less attention has been given to non-cognitive symptoms, such as neuropsychiatric symptoms (NPS). 6,7 Neuropsychiatric symptoms encompass a broad range of affective and psychotic symptoms, such as depression, apathy, anxiety, and delusions. 8 These symptoms not only affect people with dementia of various stages and etiologies but are also highly prevalent in advance of dementia, affecting over 80% of PwMCI, 9 and associating with a poor quality of life, 10 greater functional impairment, 11 and even an accelerated progression to dementia.…”

“…5 Currently, the mainstay of treatment is cognitive optimization, while less attention has been given to non-cognitive symptoms, such as neuropsychiatric symptoms (NPS). 6,7…”