Treatment Indications in Clinical Practice and Applied Research on Psychosocial Interventions for People With Dementia

Abstract

A recent review of Cochrane meta-analyses on psychosocial interventions (PIs) concludes that clinical trials fail to confirm PIs effective for all types of dementia at every stage of the disease. This article describes how and to what extent it is necessary to identify treatment indications when researching PIs and employing them in clinical practice. Twelve Cochrane reviews on PIs for people with dementia, selected because of their systematic methodology, were searched to identify outcomes related to treatment indications (dosage, type of dementia, severity…). The authors identified several research and practice issues that related to treatment indications: sample profiling, hypothesizing and statistical interpretation, external validity, effectiveness of interventions, contraindications and limits of interventions, and tailoring. Developing an effective PI requires empirical, developmental, exploratory, and confirmatory development stages to achieve credibility and robustness.

Identification of a Cascade of Changes in Activities of Daily Living Preceding Short-Term Clinical Deterioration in Mild Alzheimer’s Disease Dementia via Lead-Lag Analysis

“…Time-saving and easy to apply instruments, whose longitudinal changes precede a cascade of changes in other neuropsychological instruments and consequent pronounced clinical deterioration, are essential for planning appropriate pharmacological and psychosocial interventions. Timely implementation of such measures might compensate, maintain, or enhance neuropsychological abilities, improve the quality of life of both patients and caregivers by reducing distress, depression, and psychological morbidity, facilitate planning of subsequent care, personal, financial and health-related decision-making, and delay nursing home admission of patients [4][5][6]. Although most studies monitoring longitudinal changes focused on the Mini-Mental State Examination (MMSE) [3,[7][8][9][10][11], the Clinical Dementia Rating-Sum of Boxes (CDR-SOB) [3,9,12], and the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-Cog) [3,8,9,11,13,14], the most optimal instrument reflecting longitudinal disease progression in mild dementia of Alzheimer-type remains elusive [9].…”