Abstract
Objectives
We summarized and compared meta-analyses of pharmacologic and nonpharmacologic interventions
targeting physical health outcomes among people with dementia.
Design
This is a systematic review and meta-analysis.
Setting and Participants
People with dementia, confirmed through validated assessment measures.
Methods
Major databases were searched until October 21, 2019. Effect sizes [standardized mean
difference (SMD)/Hedges g or risk ratio (RR)] were compared separately.
Results
Of 3773 search engine hits, 4 meta-analyses were included, representing 31 meta-analyzed
trials and 10,054 study participants. Although meta-analyses were generally of adequate
high quality, meta-analyzed studies were less so. Nutritional supplements were the
only one to show a weight-increasing effect [SMD 0.53, 95% confidence interval (CI)
0.38–0.68, ie, medium effect; N = 12, n = 748]. Acetylcholinesterase inhibitors are
associated with an increased risk for weight loss (RR 2.1, 95% CI 1.5‒3.0; N = 9,
n = 7010). For the treatment of pain, sensory stimulation has a medium effect (SMD
–0.58, 95% CI –0.99 to −0.17; N = 6, n = 199), whereas physical activity has a small
effect (SMD –0.24, 95% CI –1.06 to 0.59; N = 2, n = 75). When exploring the characteristics
of the psychosocial interventions, group-based interventions demonstrated a medium
(SMD –0.55, 95% CI –1.02 to −0.09; N = 6, n = 157) and individual psychosocial interventions
a small effect (SMD –0.27, 95% CI –1.06 to 0.53; N = 2, n = 55).
Conclusions and Implications
Despite frequent physical comorbidities, the current evidence for pharmacologic and
nonpharmacologic interventions in people with dementia to prevent and treat these
conditions is still in its infancy, and larger trials targeting a wide range of physical
health outcomes are urgently needed. Based on the SMDs and RRs, nutritional supplements
can be recommended as an intervention to treat malnutrition. Clinicians should be
careful in treating patients with acetylcholinesterase inhibitors, as it shows medium
weight reducing effects. For the treatment of comorbid pain, sensory stimulation and
psychosocial interventions are recommended.
Key words
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Included meta-analyses
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Article info
Publication history
Published online: February 18, 2020
Footnotes
This research did not receive any funding from agencies in the public, commercial, or not-for-profit sectors.
The authors declare no conflicts of interest.
Identification
Copyright
© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
