Non-Pharmacological Interventions for the Treatment of Behavioral and Psychological Symptoms of Dementia

Most patients diagnosed with dementia experience behavioral and psychiatric symptoms (BPSD) including agitation, delusions, paranoia, wandering, apathy, and sleep disturbances. These BPSDs are often associated with poor patient and caregiver outcomes. Antipsychotics are utilized to treat these symptoms however antipsychotics may have adverse effects when used in patients with dementia. In addition, these medications may lack significant efficacy. Despite their risk and lack of efficacy, the use of antipsychotics for the treatment of BPSD remains prevalent. The aim of this work is to review the non-pharmacological interventions that have been tested in controlled studies.

A comprehensive review of the literature published between 2010 and 2018 was conducted. Search terms included “non-pharmacological”, “interventions” “behavioral and psychological symptoms”, “BPSD”, and “dementia”. Three databases were searched including CINAHL, Pubmed, and EMBASE. Studies published in languages other than English were excluded. Lateral search strategies were also employed. These included using reference lists from relevant papers returned in the database search and the ‘cited by’ and ‘similar articles’ features on PubMed.

Preliminary review of the literature suggests that non-pharmacological interventions are a potentially efficacious alternative to pharmacological treatments for BPSDs. We identified 12 papers which utilized various non-pharmacological interventions in controlled trials. Multiple studies looked at exercise, aroma therapy, and music therapy. There’s potential for more research in other areas such as art therapy, doll therapy, ECT, massage therapy, meaningful activity, pet therapy, reminiscence.

A better understanding of problems associated with BPSDs and their treatment will provide a base for determining the efficacy of non-pharmacological treatment options which could improve patient/caregiver outcomes. A significant number of people living with dementia have comorbidities. Thus, a clear understanding of effective BPSD management is essential not just for long-term care professionals but also acute care workers. Further research of identified alternative methods would set up a future evidenced based project to be implemented in a clinical setting such as an urban medical center.