Indian Journal of Private Psychiatry

Register      Login

VOLUME 13 , ISSUE 2 ( July-December, 2019 ) > List of Articles


Nonpharmacological Management of Dementia: A Review

Pragya Lodha

Keywords : Dementia, Home-based management, Nonpharmacological management, Occupational therapy, Psychotherapy

Citation Information : Lodha P. Nonpharmacological Management of Dementia: A Review. Ind J Priv Psychiatry 2019; 13 (2):62-70.

DOI: 10.5005/jp-journals-10067-0038

License: CC BY-NC 4.0

Published Online: 01-08-2016

Copyright Statement:  Copyright © 2019; The Author(s).


Dementia is a complex neuropsychiatric disorder that needs medical and nonpharmacological approaches for its long-term management. This review aims at providing an overview of the various nonpharmacological strategies employed in the long-term management of dementia. The paper looks at various treatment approaches like occupational therapy, methods to improve daily living, alternative medicine approaches, and various innovative approaches like animal-assisted and pet therapy. The paper also outlines various forms of psychotherapy and cognitive enhancement methods that may be used for patients and their caregivers alike. Certain general guidelines for the nonpharmacological management of dementia at home are suggested, which shall enhance the quality of life of patients with dementia.

  1. Das SK, Pal S, Ghosal MK. Dementia: Indian scenario. Neurol India 2012;60(6):618–624. DOI: 10.4103/0028-3886.105197.
  2. Rodriguez JJ, Ferri CP, Acosta D, et al. Prevalence of dementia in Latin America, India, and China: a population-based cross-sectional survey. Lancet 2008;372(9637):464–474. DOI: 10.1016/S0140-6736(08) 61002-8.
  3. Ferri CP, Prince M, Brayne C, et al. Global prevalence of dementia: a Delphi consensus study. Lancet 2005;366(9503):2112–2117. DOI: 10.1016/S0140-6736(05)67889-0.
  4. Blankevoort CG, Van Heuvelen MJ, Boersma F, et al. Review of effects of physical activity on strength, balance, mobility and ADL performance in elderly subjects with dementia. Dementia Geriatr Cogn Disord 2010;30(5):392–402. DOI: 10.1159/000321357.
  5. Ijmker T, Lamoth CJ. Gait and cognition: the relationship between gait stability and variability with executive function in persons with and without dementia. Gait Posture 2012;35(1):126–130. DOI: 10.1016/j.gaitpost.2011.08.022.
  6. Douglas S, James I, Ballard C. Non-pharmacological interventions in dementia. Adv Psychiatr Treat 2004;10(3):171–177. DOI: 10.1192/apt.10.3.171.
  7. Cummings J, Lee G, Mortsdorf T, et al. Alzheimer's disease drug development pipeline: 2017. Alzheimers Dement (N Y) 2017;3(3): 367–384. DOI: 10.1016/j.trci.2017.05.002.
  8. Brodaty H, Arasaratnam C. Meta-analysis of nonpharmacological interventions for neuropsychiatric symptoms of dementia. Am J Psychiatry 2012;169(9):946–953. DOI: 10.1176/appi.ajp.2012.11101529.
  9. Livingston G, Kelly L, Lewis-Holmes E, et al. Non-pharmacological interventions for agitation in dementia: systematic review of randomised controlled trials. Br J Psychiatry 2014;205(6):436–442. DOI: 10.1192/bjp.bp.113.141119.
  10. Morris RG. The cognitive neuropsychology of Alzheimer-type dementia. London: Oxford University Press; 1996.
  11. Cerejeira J, Lagarto L, Mukaetova-Ladinska E. Behavioral and psychological symptoms of dementia. Front Neurol 2012;3:73. DOI: 10.3389/fneur.2012.00073.
  12. Kolanowski AM, Litaker M, Buettner L. Efficacy of theory-based activities for behavioral symptoms of dementia. Nurs Res 2005;54(4):219–228. DOI: 10.1097/00006199-200507000-00003.
  13. Gitlin LN, Winter L, Dennis MP, et al. Targeting and managing behavioral symptoms in individuals with dementia: a randomized trial of a nonpharmacological intervention. J Am Geriatr Soc 2010;58(8):1465–1474. DOI: 10.1111/j.1532-5415.2010.02971.x.
  14. Gitlin LN, Kales HC, Lyketsos CG. Nonpharmacologic management of behavioral symptoms in dementia. JAMA 2012;308(19):2020–2029. DOI: 10.1001/jama.2012.36918.
  15. Ayalon L, Gum AM, Feliciano L, et al. Effectiveness of nonpharmacological interventions for the management of neuropsychiatric symptoms in patients with dementia: a systematic review. Arch Intern Med 2006;166(20):2182–2188. DOI: 10.1001/archinte.166.20.2182.
  16. Brodaty H, Burns K. Nonpharmacological management of apathy in dementia: a systematic review. Am J Geriatr Psychiatry 2012;20(7):549–564. DOI: 10.1097/JGP.0b013e31822be242.
  17. Ballard CG, O'Brien J, James I, et al. Dementia: management of behavioural and psychological symptoms. Nordic J Psychiatry 2003;57(2):159–160. DOI: 10.1080/08039480310001571.
  18. Cohen-Mansfield J. Theoretical frameworks for behavioral problems in dementia. Alzheimer Care Today 2000;1(4):8–21.
  19. Hogan DB, Bailey P, Black S, et al. Diagnosis and treatment of dementia: 5. Nonpharmacologic and pharmacologic therapy for mild to moderate dementia. Can Med Assoc J 2008;179(10):1019–1026. DOI: 10.1503/cmaj.081103.
  20. Turner S. Behavioural symptoms of dementia in residential settings: a selective review of non-pharmacological interventions. Aging Ment Health 2005;9(2):93–104. DOI: 10.1080/13607860512331339090.
  21. Kales HC, Gitlin LN, Lyketsos CG, et al. Management of neuropsychiatric symptoms of dementia in clinical settings: recommendations from a multidisciplinary expert panel. J Am Geriatr Soc 2014;62(4):762–769. DOI: 10.1111/jgs.12730.
  22. Carlson DL, Fleming KC, Smith GE, et al. Management of dementia-related behavioral disturbances: a nonpharmacologic approach. Mayo Clin Proceed 1995;70(11):1108–1115. DOI: 10.4065/70.11.1108.
  23. Seitz DP, Brisbin S, Herrmann N, et al. Efficacy and feasibility of nonpharmacological interventions for neuropsychiatric symptoms of dementia in long term care: a systematic review. J Am Med Dir Assoc 2012;13(6):503–506. DOI: 10.1016/j.jamda.2011.12.059.
  24. Gitlin LN, Winter L, Dennis MP, et al. A non-pharmacological intervention to manage behavioral and psychological symptoms of dementia and reduce caregiver distress: design and methods of project ACT3. Clin Interv Aging 2007;2(4):695–703. DOI: 10.2147/cia.s1337.
  25. Ballard C, Corbett A. Management of neuropsychiatric symptoms in people with dementia. CNS Drugs 2010;24(9):729–739. DOI: 10.2165/11319240-000000000-00000.
  26. Deudon A, Maubourguet N, Gervais X, et al. Non-pharmacological management of behavioural symptoms in nursing homes. Int J Geriatr Psychiatry 2009;24(12):1386–1395. DOI: 10.1002/gps.2275.
  27. Algase DL, Beck C, Kolanowski A, et al. Need-driven dementia-compromised behavior: an alternative view of disruptive behavior. Am J Alzheimer Dis 1996;11(6):10–19. DOI: 10.1177/153331759601100603.
  28. Allen-Burge R, Stevens AB, Burgio LD. Effective behavioral interventions for decreasing dementia-related challenging behavior in nursing homes. Int J Geriatr Psychiatry 1999;14(3):213–228. DOI: 10.1002/(SICI)1099-1166(199903)14:3<213::AID-GPS974>3.0.CO;2-0.
  29. Spector A, Davies S, Woods B, et al. Reality orientation for dementia: a systematic review of the evidence of effectiveness from randomized controlled trials. Gerontologist 2000;40(2):206–212. DOI: 10.1093/geront/40.2.206.
  30. Spector A, Orrell M, Davies S, et al. Can reality orientation be rehabilitated? Development and piloting of an evidence-based programme of cognition-based therapies for people with dementia. Neuropsychol Rehabil 2001;11(3–4):377–397. DOI: 10.1080/09602010143000068.
  31. Feil N. The validation breakthrough: Simple techniques for communicating with people with Alzheimer's-type dementia. New York: Health Professions Press; 1993.
  32. Bleathman C, Morton I. Validation therapy: extracts from 20 groups with dementia sufferers. J Adv Nurs 1992;17(6):658–666. DOI: 10.1111/j.1365-2648.1992.tb01961.x.
  33. Subramaniam P, Woods B. The impact of individual reminiscence therapy for people with dementia: systematic review. Exp Rev Neurotherapeut 2012;12(5):545–555. DOI: 10.1586/ern.12.35.
  34. Woods B, O'Philbin L, Farrell EM, et al. Reminiscence therapy for dementia. Cochrane Database Sys Rev 2018;3:CD001120. DOI: 10.1002/14651858.CD001120.pub3.
  35. Svansdottir HB, Snædal J. Music therapy in moderate and severe dementia of Alzheimer's type: a case-control study. Int Psychogeriatr 2006;18(4):613–621. DOI: 10.1017/S1041610206003206.
  36. Raglio A, Bellelli G, Traficante D, et al. Efficacy of music therapy in the treatment of behavioral and psychiatric symptoms of dementia. Alzheimer Dis Assoc Disord 2008;22(2):158–162. DOI: 10.1097/WAD.0b013e3181630b6f.
  37. McDermott O, Crellin N, Ridder HM, et al. Music therapy in dementia: a narrative synthesis systematic review. Int J Geriatr Psychiatry 2013;28(8):781–794. DOI: 10.1002/gps.3895.
  38. Beard RL. Art therapies and dementia care: a systematic review. Dementia 2012;11(5):633–656. DOI: 10.1177/1471301211421090.
  39. Burton A. Bringing arts-based therapies in from the scientific cold. Lancet Neurol 2009;8(9):784–785. DOI: 10.1016/S1474-4422(09)70216-9.
  40. Politis AM, Vozzella S, Mayer LS, et al. A randomized, controlled, clinical trial of activity therapy for apathy in patients with dementia residing in long-term care. Int J Geriatr Psychiatry 2004;19(11): 1087–1094. DOI: 10.1002/gps.1215.
  41. Hokkanen L, Rantala L, Remes AM, et al. Dance/movement therapeutic methods in management of dementia. J Am Geriatr Soc 2003;51(4):576–577. DOI: 10.1046/j.1532-5415.2003.51175.x.
  42. Meland B. Effects of Reiki on pain and anxiety in the elderly diagnosed with dementia: a series of case reports. Altern Ther Health Med 2009;15(4):56–57.
  43. Fowler S, Newton L. Complementary and alternative therapies: the nurse's role. J Neurosci Nurs 2006;38(4):261–266. DOI: 10.1097/01376517-200608000-00009.
  44. Yu J, Zhang X, Liu C, et al. Effect of acupuncture treatment on vascular dementia. Neurol Res 2006;28(1):97–103. DOI: 10.1179/016164106X91951.
  45. Kwok T, Leung PC, Wing YK, et al. The effectiveness of acupuncture on the sleep quality of elderly with dementia: a within-subjects trial. Clin Interv Aging 2013;8:923–928. DOI: 10.2147/CIA.S45611.
  46. Snow LA, Hovanec L, Brandt J. A controlled trial of aromatherapy for agitation in nursing home patients with dementia. J Altern Complement Med 2004;10(3):431–437. DOI: 10.1089/1075553041323696.
  47. Burns A, Allen H, Tomenson B, et al. Bright light therapy for agitation in dementia: a randomized controlled trial. Int Psychogeriatr 2009;21(4):711–721. DOI: 10.1017/S1041610209008886.
  48. Baker R, Bell S, Baker E, et al. A randomized controlled trial of the effects of multi-sensory stimulation (MSS) for people with dementia. Br J Clin Psychol 2001;40(1):81–96. DOI: 10.1348/014466501163508.
  49. Zetteler J. Effectiveness of simulated presence therapy for individuals with dementia: a systematic review and meta-analysis. Aging Ment Health 2008;12(6):779–785. DOI: 10.1080/13607860802380631.
  50. Cheston R, Thorne K, Whitby P, et al. Simulated presence therapy, attachment and separation amongst people with dementia. Dementia 2007;6(3):442–449. DOI: 10.1177/14713012070060030703.
  51. Staal JA, Matheis R, Collier L, et al. The effects of Snoezelen (multi-sensory behavior therapy) and psychiatric care on agitation, apathy, and activities of daily living in dementia patients on a short term geriatric psychiatric inpatient unit. Int J Psychiatry Med 2007;37(4):357–370. DOI: 10.2190/PM.37.4.a.
  52. Scherder EJ, Bouma A, Steen L. Influence of transcutaneous electrical nerve stimulation on memory in patients with dementia of the Alzheimer type. J Clin Exp Neuropsychol 1992;14(6):951–960. DOI: 10.1080/01688639208402546.
  53. Heyn P, Abreu BC, Ottenbacher KJ. The effects of exercise training on elderly persons with cognitive impairment and dementia: a meta-analysis. Arch Phys Med Rehabil 2004;85(10):1694–1704. DOI: 10.1016/j.apmr.2004.03.019.
  54. Cahill S, Woods B, Droes RM, et al. Early psychosocial interventions in dementia: evidence-based practice. New York: Jessica Kingsley Publishers; 2008.
  55. Shaw FE. Falls in cognitive impairment and dementia. Clin Geriatr Med 2002;18(2):159–173. DOI: 10.1016/S0749-0690(02)00003-4.
  56. Sadowsky CH, Galvin JE. Guidelines for the management of cognitive and behavioral problems in dementia. J Am Board Fam Med 2012;25(3):350–366. DOI: 10.3122/jabfm.2012.03.100183.
  57. Kitwood T. Towards a theory of dementia care: the interpersonal process. Ageing Soc 1993;13(1):51–67. DOI: 10.1017/S0144686X00000647.
  58. Kasl-Godley J, Gatz M. Psychosocial interventions for individuals with dementia: an integration of theory, therapy, and a clinical understanding of dementia. Clin Psychol Rev 2000;20(6):755–782. DOI: 10.1016/S0272-7358(99)00062-8.
  59. Fan JT, Chen KM. Using silver yoga exercises to promote physical and mental health of elders with dementia in long-term care facilities. Int Psychogeriatr 2011;23(8):1222–1230. DOI: 10.1017/S1041610211000287.
  60. Oken BS, Fonareva I, Haas M, et al. Pilot controlled trial of mindfulness meditation and education for dementia caregivers. J Altern Complement Med 2010;16(10):1031–1038. DOI: 10.1089/acm.2009.0733.
  61. Graff MJ, Vernooij-Dassen MJ, Thijssen M, et al. Community based occupational therapy for patients with dementia and their care givers: randomised controlled trial. BMJ 2006;333(7580):1196. DOI: 10.1136/bmj.39001.688843.BE.
  62. Clare L, Woods RT. Cognitive training and cognitive rehabilitation for people with early-stage Alzheimer's disease: a review. Neuropsychol Rehabil 2004;14(4):385–401. DOI: 10.1080/09602010443000074.
  63. Brooker D, Duce L. Wellbeing and activity in dementia: a comparison of group reminiscence therapy, structured goal-directed group activity and unstructured time. Aging Ment Health 2000;4(4): 354–358. DOI: 10.1080/713649967.
  64. Chien LY, Chu H, Guo JL, et al. Caregiver support groups in patients with dementia: a meta-analysis. Int J Geriatr Psychiatry 2011;26(10):1089–1098. DOI: 10.1002/gps.2660.
  65. Belle SH, Burgio L, Burns R, et al. Enhancing the quality of life of dementia caregivers from different ethnic or racial groups: a randomized, controlled trial. Ann Intern Med 2006;145(10):727–738. DOI: 10.7326/0003-4819-145-10-200611210-00005.
  66. Gwyther LP, Blazer DG. Family therapy and the dementia patient. Am Fam Physician 1984;29(5):149–156.
  67. Brodaty H, Donkin M. Family caregivers of people with dementia. Dialog Clin Neurosci 2009;11(2):217–228.
  68. Clare L. Neuropsychological rehabilitation and people with dementia. UK: Psychology Press; 2007.
  69. Galvin JE, Valois L, Zweig Y. Collaborative transdisciplinary team approach for dementia care. Neurodegen Dis Manage 2014;4(6): 455–469. DOI: 10.2217/nmt.14.47.
  70. Feart C, Samieri C, Rondeau V, et al. Adherence to a mediterranean diet, cognitive decline, and risk of dementia. JAMA 2009;302(6): 638–648. DOI: 10.1001/jama.2009.1146.
  71. Mitchell SL, Morris JN, Park PS, et al. Terminal care for persons with advanced dementia in the nursing home and home care settings. J Palliative Med 2004;7(6):808–816. DOI: 10.1089/jpm.2004.7.808.
  72. Dias A, Dewey ME, D'Souza J, et al. The effectiveness of a home care program for supporting caregivers of persons with dementia in developing countries: a randomised controlled trial from Goa, India. PloS One 2008;3(6):e2333. DOI: 10.1371/journal.pone.0002333.
  73. Camp CJ, Foss JW, O'Hanlon AM, et al. Memory interventions for persons with dementia. Appl Cogn Psychol 1996;10(3):193–210. DOI: 10.1002/(SICI)1099-0720(199606)10:3<193::AID-ACP374>3.0. CO;2-4.
  74. Christofoletti G, Oliani MM, Gobbi S, et al. Effects of motor intervention in elderly patients with dementia: an analysis of randomized controlled trials. Topics Geriatr Rehabil 2007;23(2): 149–154. DOI: 10.1097/01.TGR.0000270183.90778.8e.
  75. Zarit SH, Femia EE. A future for family care and dementia intervention research? Challenges and strategies. Aging Ment Health 2008;12(1): 5–13. DOI: 10.1080/13607860701616317.
  76. Yu F, Rose KM, Burgener SC, et al. Cognitive training for early-stage Alzheimer's disease and dementia. J Gerontol Nurs 2009;35(3):23–29. DOI: 10.3928/00989134-20090301-10.
  77. Adams T, Gardiner P. Communication and interaction within dementia care triads: developing a theory for relationship-centred care. Dementia 2005;4(2):185–205. DOI: 10.1177/1471301205051092.
  78. Filan SL, Llewellyn-Jones RH. Animal-assisted therapy for dementia: a review of the literature. Int Psychogeriatr 2006;18(4):597–611. DOI: 10.1017/S1041610206003322.
  79. Motomura N, Yagi T, Ohyama H. Animal assisted therapy for people with dementia. Psychogeriatrics 2004;4(2):40–42. DOI: 10.1111/j.1479-8301.2004.00062.x.
  80. Perkins J, Bartlett H, Travers C, et al. Dog-assisted therapy for older people with dementia: A review. Australasian J Ageing 2008;27(4): 177–182. DOI: 10.1111/j.1741-6612.2008.00317.x.
  81. Khan F, Curtice M. Non-pharmacological management of behavioural symptoms of dementia. Br J Commun Nurs 2011;16(9):441–449. DOI: 10.12968/bjcn.2011.16.9.441.
  82. Cabrera E, Sutcliffe C, Verbeek H, et al. Non-pharmacological interventions as a best practice strategy in people with dementia living in nursing homes. A systematic review. Eur Geriatr Med 2015;6(2):134–150. DOI: 10.1016/j.eurger.2014.06.003.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.