Description

Νοn-pharmacological interventions embody one of the backbones of dementia treatment. Taking into account that currently available anti-dementia drugs exert only moderate effects, do not stop the disease progression, are exclusively approved for Alzheimer’s disease and (partly) Parkinson’s syndrome and that they are can cause side-effects endangering the quality of life of people with dementia (e.g. falls, negative impact of cognitive function and mobility), non-pharmacological interventions form pragmatic (first-line or add-on) treatment strategies. They are well tolerated, empower people with dementia, facilitate self-management, and support informal caregivers. Even in the case of the development of new pharmacological agents being in the position to decelerate or even stop the progression of brain pathological processes, non-pharmacological interventions will not decline in importance. The new therapeutic strategies are expected to prolong the time that affected people will spend at mild and moderate dementia stages and not eliminate dementia, which is in most cases not engendered by a single pathological process, but is the result of a complex interplay between variable brain pathological mechanisms (e.g. Alzheimer’s disease, cerebrovascular alterations, Lewy-bodies), harmful and protective environmental factors (e.g. diet and lifestyle parameters, mental and physical activity). Non-pharmacological interventions can be classified into six major groups, according to whether they are focused on cognition, activities of daily living, behavior, patient wellbeing, physical fitness or caregiver skills and coping abilities. Cognitive stimulation, cognitive training and reminiscence therapy improve cognitive ability, whilst they influence activities of daily living only minimally. Cognitive rehabilitation and occupational therapy enhance performance on everyday tasks but do not exert significant effects on cognition. Cognitive-behavioral therapy and behavior modification techniques mainly ameliorate mood disturbances and challenging behaviors. Music therapy, validation and multi-sensory stimulation are strategies to combat problem behaviours. Physical exercise increases bodily fitness and improves performance of day-to-day tasks. Caregiver support alleviates depressive symptoms and emotional burden, and educational programs regarding behavior management contribute to the reduction of challenging behaviors of people with dementia.

The different types of non-pharmacological interventions are indicated at different stages of the syndrome course. Interventions targeting cognitive function and activities of daily living are most useful at earlier stages of dementia (i.e. mild dementia), whilst at more advanced stages treatments are mainly focused on aggression, aimless wandering and further behavioural symptoms. At the stage of severe dementia interventions aiming to preserve the well-being of people with dementia are the most proper. Of note, caregiver counseling and support as well as assistive technologies play a crucial role during the entire course of dementia. Regarding assistive technologies, devices supporting independence, functioning, participation and communication are valuable in mild to moderate dementia; Safety and monitoring devices are more useful in more severe phases of the syndrome.

The implementation of non-pharmacological interventions in routine everyday care is confronted with a number of unresolved issues. There are still unclarities concerning optimal dosage schemata and duration of each intervention, potential benefits or contraindications of treatment combinations, the potential of modes of treatment delivery using modern information technology, as well as ways to increase treatment motivation and adherence.